Comparison of peribulbar with posterior sub-tenon′s anesthesia in cataract surgery among Nigerians

Iganga, Ogbonnaya N; Fasina, Oluyemi; Bekibele, CO; Ajayi, Benedictus G K; Ogundipe, Ayobade O.

doi:10.4103/0974-9233.164609

Cited by 12 publications

(7 citation statements)

References 24 publications

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“…Our study has the advantage of using similar amount (6 ml) of anesthetic mixture in both techniques. Similarly, a study in which the same volume of anesthetic solution was used for BPA and STA in cataract surgery showed nonsignificant differences in the quality of globe akinesia [18]. Furthermore, assessment of the efficacy of BPA and STA in anterior segment eye surgeries revealed significantly higher akinesia scores with BPA (mean 2.79 ± 0.43) compared to STA (mean 2.56 ± 0.66) [19].…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study Between Single Medial Canthus Injection Using 13 x 0.45 mm Needle and Posterior Sub-Tenon Injection as Local Anesthesia Techniques for Strabismus Surgery in Adults

Sherif¹,

Mohamad²,

Hannon³

et al. 2020

TOATJ

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Background: The quality of ophthalmic anesthesia is an important component of the surgical procedure. There is no absolutely well-tolerated local eye anesthetic technique. However, it is important to choose a technique with high efficacy and safety. Objective: This study aimed to compare the efficacy and safety of peribulbar block using medial canthus single injection and posterior sub-tenon injection techniques. Methods: This prospective observational study was carried out at the Research Institute of Ophthalmology, Cairo, Egypt during the period from March to December 2018. Consecutive 60 patients of both sexes, aged >18 years-old, scheduled for bilateral strabismus surgery were enrolled in this study. In one eye of the sixty patients, medial canthus single injection peribulbar anesthesia was used (Group A), whereas posterior sub-tenon technique was applied in the other eye (Group B). Results: The median total ocular akinesia score was significantly higher in group A than in group B when assessed at 1, 3, and 5 min (p < 0.001). Each of the intraoperative (at 5 min) and postoperative pain scores showed no significant differences between the two groups (p > 0.05). However, the median scores of surgeon and patient satisfaction were significantly higher in group A compared with group B (3 vs. 2 each, p < 0.05). No patient developed occulocardiac reflex or postoperative nausea and vomiting. Conclusion: Peribulbar anesthesia by medial canthus single injection showed better akinesia of the globe than sub-tenon injection technique. Otherwise, both techniques were equally effective and safe.

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Section: Discussionmentioning

confidence: 99%

A Comparative Study Between Single Medial Canthus Injection Using 13 x 0.45 mm Needle and Posterior Sub-Tenon Injection as Local Anesthesia Techniques for Strabismus Surgery in Adults

Sherif¹,

Mohamad²,

Hannon³

et al. 2020

TOATJ

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“…In many parts of the world, particularly in developing countries, MSICS forms a significant chunk of cataract surgeries performed. 15 25 It has also been advocated as a valuable skill in developed countries, especially for surgical conversion and to deal with complex and advanced cataract cases, and has been recommended to be a part of resident training programs in the developed world. 26 This is largely due to the ability of MSICS to provide a safe and effective method of cataract removal without having to depend on expensive instrumentation and steep learning curves.…”

Section: Discussionmentioning

confidence: 99%

“… 5 9 10 This is even though multiple authors and reviews have shown the effectiveness and relative painlessness of STA. 9 14 15 16 27 This could be because STA is still not commonly performed in many training centers and involves the learning of a slightly different and newer method of administering anesthesia. Moreover, the administration of STA involves the deep posterior passage of the cannula for delivery of anesthetic, and there has been a report of perforation associated with STA also.…”

Section: Discussionmentioning

confidence: 99%

“… 11 12 13 Sub-tenon's anesthesia (STA), less invasive than peribulbar, has been found to be as safe and effective as peribulbar anesthesia and is more comfortable to the patient at the time of administration. 9 14 15 16 Subconjunctival anesthesia is further less invasive than sub-tenon's and is simpler to administer, 17 but has not been studied extensively for its efficacy and safety for performing MSICS.…”

Section: Introductionmentioning

confidence: 99%

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Anterior Subconjunctival Anesthesia for Manual Small Incision Cataract Surgery

Ajay¹,

Subhasree

Poka

2021

Journal of Current Ophthalmology

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Purpose: To compare the effectiveness of anterior subconjunctival anesthesia (ASCA) with sub-tenon's anesthesia (STA) for manual small incision cataract surgery (MSICS), regarding pain, akinesia, surgeon comfort, and complications. Methods: This trial randomized 164 patients into two groups. Group 1 received ASCA, and Group 2 received STA. MSICS was performed on all patients. Any complications of anesthesia were noted before starting surgery. Patient ocular motility during surgery was scored between 0 and 4 based on the number of directions of gaze in which movement persisted. Following surgery, patients scored pain felt during surgery on a visual pain-score analog, and the surgeon graded for “discomfort” felt during surgery from 0 (Nil) to 4 (additional anesthesia needed). Results: Chemosis due to anesthesia and persistence of ocular motility in all four gaze directions were seen in all 82 patients of Group 1, but these did not prevent the surgeon from performing MSICS. Seventy-seven patients (94%) in Group 1 and 79 (96.4%) in Group 2 had no or mild pain during surgery. The surgeon had moderate-to-severe discomfort in 14 (17.2%) Group 1 patients and 3 (3.6%) Group 2 patients, most of whom had deep-set eyes or exhibited excessive eye movements. Two patients in Group 1 and one patient in Group 2 were converted to peribulbar block. Conclusion: ASCA is a safe and effective alternative for performing MSICS. It does not induce akinesia but provides adequate anesthesia for the surgery in most patients, except those with deep-set eyes, especially if displaying increased anxiety.

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“…Akinesia was less with a metal subtenon canula compared to flexible medium or flexible posterior cannulas [37] . In a hospital-based randomized comparative interventional study of uncomplicated cataract surgery who received either peribulbar block or posterior sub-tenon block, Igana et al [38] reported that both routes of administering anesthetic substances is comparable in providing adequate akinesia and analgesia for cataract surgery with minimal complications, and both techniques are effective and safe.…”

Section: Akinesiamentioning

confidence: 99%

Local Anaesthesia in Cataract Surgery

Reddy

Thevi

2017

International Journal of Ophthalmic Research

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nerves of the cornea and the conjunctiva (long and short ciliary nerves, nasociliary nerves). This technique eliminates the possible complications of injectable anesthesia. However, it does not eliminate pain sensitivity of the iris, the zonule, and the ciliary body which is achieved by intracameral technique of anesthesia with preservative free 1% lidocaine. In a constantly evolving arena, the sub-Tenon's block has gained popularity while the deep angulated intraconal (retrobulbar) block has been largely superseded by the shallower extraconal (peribulbar) approach. Hyaluronidase is a useful adjuvant because it promotes local anesthetic diffusion and hastens block onset time but there is a possibility of getting an allergic reaction. Ultrasound-guided eye blocks afford real-time visualization of needle position and local anesthetic spread. An advantage of sonic guidance is that it may eliminate the hazard of globe perforation by identifying abnormal anatomy, such as staphyloma. INTRODUCTIONThe ideal anaesthesia would be one that provides adequate pain relief during surgery and postoepratively, be easy to administer and have minimal complications. For doing cataract surgery, the anaesthesia could be local or general. Majority of cataract patients are operated under local anaesthesia (infiltration, topical, intracameral). The infiltration anaesthesia is given as retrobulbar or peribulbar or subTenon's block. Carl Koller first used cocaine as a topical anaesthetic for eye surgery in 1884 [1] . The general anaesthesia has its own complications in elderly cataract patients and most of them may have diabetes or hypertension or heart diseases or combination of them. No need of fasting before or after surgery, no need of intubation, no need of using any systemic medications are the advantages of local anaesthesia. However, cataract in children, patients with parkinsonism, deaf mute patients, mental retardation patients, patients ABSTRACTThere has been a significant evolution in surgical technique of cataract extraction. The technical advances in phaco machines, phacotips, and availability of ophthalmic viscoelastic devices have played a great role in cataract surgery to be faster and more controlled now than before. Similarly, local anesthesia techniques in cataract surgery have also advanced significantly from retrobulbar, peribulbar, sub-Tenon's, to topical anaesthesia. Even though, the sub-Tenon's anesthesia technique reduced the risk of complications of peribulbar/ retrobulbar anesthesia but the technique is still associated with a possibility of damage to optic nerve, retrobulbar hemorrhage, and ocular muscle injury. Topical anesthesia is used to block the afferent EDITORIAL

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Comparison of peribulbar with posterior sub-tenon′s anesthesia in cataract surgery among Nigerians

Cited by 12 publications

References 24 publications

A Comparative Study Between Single Medial Canthus Injection Using 13 x 0.45 mm Needle and Posterior Sub-Tenon Injection as Local Anesthesia Techniques for Strabismus Surgery in Adults

A Comparative Study Between Single Medial Canthus Injection Using 13 x 0.45 mm Needle and Posterior Sub-Tenon Injection as Local Anesthesia Techniques for Strabismus Surgery in Adults

Anterior Subconjunctival Anesthesia for Manual Small Incision Cataract Surgery

Local Anaesthesia in Cataract Surgery

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