Drop, then decide approach to topical anesthesia

Abstract

I developed an approach to topical anesthesia--drop, then decide--with the goal of increasing the percentage of patients able to have topical anesthesia for anterior segment surgery. This study comprised 150 consecutive surgeries performed using the technique, including cataract extraction with intraocular lens (IOL) implantation, trabeculectomy, combined procedures, and McCannel suturing. Six patients also had anterior vitrectomy. Patients were not preselected. All cases were initiated with topical anesthesia and supplemented with at least mild intravenous sedation by an anesthesiologist. The decision on whether to use anesthetic blocks was made after evaluating patient response early in the surgery. The approach had an overall success rate (no regional block needed) of 89.3%; 92.0% of the cataract/IOL implantation cases were successful. Most patients reported they were comfortable throughout the procedure. The success rate was high among patients who may be considered poor candidates for topical anesthesia; younger patients had more difficulty. This approach allows more patients to benefit from the advantages of topical anesthesia over other techniques.

Comparative clinical trial of topical anaesthetic agents for cataract surgery with phacoemulsification: lidocaine 2% drops, levobupivacaine 0.75% drops, and ropivacaine 1% drops

“…29,30 Martini et al 12 showed that topical ropivacaine is safe in endothelial toxicity and seemed to be a good alternative to lidocaine, but could cause transient corneal oedema. None of our patients in the ropivacaine group displayed any kind of corneal oedema.…”

Topical plus subconjunctival anaesthesia: foldable intraocular lens implantation in eyes without capsule support through a self‐sealing incision

“…This method avoids the risks associated with peribulbar, subtenonal or retrobulbar anaesthesia, such as periocular bruising or swelling, ptosis, optic nerve injury, orbital haemorrhage, central retinal artery or vein occlusion, brain-stem anaesthesia and even death (Petersen & Yanoff 1992). In addition, because the eye is left unpatched, postoperative visual recovery is immediate and ocular motility normal (Dinsmore 1995;Tranos & Peter 2006). Analysis of the data demonstrates that combined topical and subconjunctival anaesthesia is a technique that is safe and effective.…”

Estudo histopatológico da retina de coelhos após injeção intravítrea de lidocaína

“…As estatísticas não são uniformes e variam de acordo com os cirurgiões (23)(24)(25) . Neste estudo, pela microscopia de luz, não foram encontradas alterações morfológicas na retina de coelhos albinos, quando foi utilizada a injeção intravítrea de lidocaína a 0,5%, 1 % e 2%, coincidindo com os achados de Zemel et al (6) , Lincoff et al (22) e Nishide et al (26) .…”