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Yuna Rapoport, Amy Chomsky, Laura Wayman; Anesthesia Choice and Pain Control during Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1825.
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The aim of this study is to determine the effect of different anesthesia modalities on pain control during cataract surgery. A secondary objective is to determine if patient age, history of anxiety disorder, and operative time affect intra-operative pain control.
This study involved a retrospective chart review of cataract surgeries within the Veterans Affairs Tennessee Valley Healthcare System, Nashville Campus, from January to September 2012. Data collected included anesthesia types (topical with no sedation, topical with sedation, retrobulbar block [RBB] and general), level of pain control (obtained from anesthesia’s intra-operative assessment on a scale from 0 to 10), intra-operative average heart rate (HR) and blood pressure (BP), history of anxiety disorder, age, complex cases (capsular tear, vitreous loss, or iris manipulation) and operative time. The data was analyzed using t-test power analysis assuming unequal variance between groups.
A total of 110 cataract surgeries were reviewed. Seven had general anesthesia, 50 had RBB, 19 had topical with no sedation, and 34 had topical with sedation. Patients that had RBB were found to have higher pain scores as compared with topical alone (mean difference=0.57, p=0.02), topical with sedation (mean difference=0.45, p=0.04), and with both types of topical (mean difference=0.5, p=0.01). HR and BP were both found to be higher in those patients who reported any pain (score > 0) than those who reported pain = 0 (each p<0.001). Operative time was significantly longer in the RBB cases than topical alone (p=0.001), topical with sedation (p=0.005), and than all topicals combined (p<0.001). There was no statistically significant difference between intra-operative pain in patients with a history of anxiety disorder and those without. Age and complex cases were also not significantly associated with pain level or type of anesthesia received.
Our data suggests that topical anesthesia with and without sedation provides better pain control and shorter operative times than RBB. The correlation between intra-operative pain assessment and intra-operative HR and BP supports the validity of the pain assessment rubric. The longer operative time with RBB however may represent more complex case selection. This study is limited by the retrospective nature and sample size.
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