Comparative Effectiveness of Anesthetics Subtenon Injection in Phacoemulsification of Cataracts

Purpose. Currently cataract surgery is a high-tech procedure that is usually performed on an outpatient basis under local anesthesia. To  perform anesthesia, novocaine, lidocaine, bupivokaine, and others  are used. The recently published articles suggest a ropivacaine as a  new anesthetic in ophthalmology. In connection with this, the  purpose of the present paper was to study the efficacy of ropivacaine in subtenon anesthesia with Phaco.

Patients and methods. We have examined 318 patients (318 eyes) with age-related cataracts, which have been operated by Phaco on  the “Infinity” (“Alcon”) device using standard methods. During the  operation, 156 patients have been under subtenon anesthesia by  administering 1.5 ml of ropivacaine solution (0.75 mg/ml). 162  patients underwent subtenon anesthesia with 1.5 ml of a 1%  solution of lidocaine. The distribution of patients by groups was  carried out using a random number generator. 

Results. 144 patients did not feel pain during the operation. Among them, most patients were anesthetized with ropivacaine (68%). Only 32% of patients operated with lidocaine anesthesia did not feel pain  (p < 0.05). Ropivacaine anesthesia had pain intensity averaged 2.1  ± 1.6 points, median 2 points (1–2), lidocaine –3.1 ± 1.5 points,  median 3 points (2–4) (U = 4,714, p < 0.001). The risk of pain  syndrome when using lidocaine in comparison with ropivacaine is  twice as high. We have found that the intensity of pain during Phaco  surgery did not have gender and age differences. There was no  dependence of the pain syndrome on the predominant type of  cataract — cortical (n = 181) or nuclear (137) ((χ2 = 1.066, p =  0.302), as well as the cataract stage.

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