A comparative study of effectiveness of topical with supplemental intracameral lignocaine versus peribulbar anaesthesia for phacoemulsification with foldable intraocular lens implantation

Abstract

To assess the quality of analgesia, level of comfort of patients and surgeons and incidence of complications after topical anaesthesia with supplemental intracameral lignocaine as compared to peribulbar block in patients undergoing phacoemulsification.It was a prospective observational study done in 66 patients having uncomplicated senile cataracts who underwent phacoemulsification with foldable IOL implantation of both eyes. One eye of each patient was operated under peribulbar blockand the other eye under topical anaesthesia with supplemental intracameral lignocaine after 2 weeks. In Group T, topical anaesthesia was achieved by instilling proparacaine hydrochloride 0.5% and preservative free 1% lignocaine was used for intracameral analgesia. Peribulbar block was administered with 5-7 ml of 2% lignocaine with 1:10000 adrenaline. Patient comfort, feeling of pressure during block, quality of analgesia intraop and 4 hours postop, and surgeon’s comfort were documented. Group P patients had significantly higher pain score, discomfort and pressure on eye during administration of block compared to Group T. Both groups had comparable pain scores and patient’s discomfort. Pressure on eye intraop and postop and intraoperative positive pressure were also similar in both groups. Group P had significantly higher incidence of subconjunctival hemorrhage (80% vs 10%) and chemosis of conjunctiva. (80% vs 0%). Topical anaesthesia with supplemental intracameral lignocaine can be considered as a superior anaesthetic technique for phacoemulsification than peribulbar block as it is associated with significantly higher patient comfort and lower complications with comparable surgeon’s comfort.