Topical Anaesthesia Versus Peribulbar Anaesthesia in Small Incision Cataract Surgery ??? A Comparative Study from Hyderabad Karnataka Region

Author(s): Sumeet Deshpande1, Rashmi R. Anwekar2, Rajashree Reddy3

Anaesthesia is an integral part of any successful surgery. Advances in cataract
surgery have led to changes in delivery of anaesthesia as well. Patient and
surgeons’ comfort during anaesthesia and surgery is the single most important
factor. In developing countries, small incision cataract is preferred sometimes over
phacoemulsification in high volume centers. This study was done to compare
patient and surgeon satisfaction following topical anaesthesia (TA) versus
peribulbar anaesthesia (PA) for small incision cataract surgery (SICS) with
intraocular lens implantation (IOL).
This comparative observational study was done at M.R. Medical College,
Kalaburagi over a period of 15 months from November 2018 to April 2020. 400
patients undergoing manual small incision cataract surgery (MSICS) after
obtaining consent were included in the study, out of which 200 patients were
administered TA while 200 were given PA randomly. Patients were prospectively
evaluated for pain during administration, during surgery and 4-hours postoperatively
through a questionnaire.
In our study TA group complained no pain whereas 85 % had mild pain and 13 %
had moderate pain in PA group during administration of anaesthesia (P < 0.05).
During surgery, none of the patients in both the groups experienced severe pain.
17 % patients in TA group had mild pain at 4 hours while only 4 % patients in PA
group had pain (P < 0.05). There was no statistically significant difference in
surgeon’s satisfaction between 2 groups.
Although the administration of PA is painful compared to TA, the patient
satisfaction was more post-operatively in PA group. Topical anaesthesia has
gained popularity due to minimal discomfort, speed of onset and lack of PA related
complications. It is a safe and effective alternative to PA in MSICS with proper
selection and education of patient.