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J. Cehajic-Kapetanovic, M. I. Wearne; Effectiveness of Techniques and Patient Satisfaction in Ocular Anaesthesia. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5660.
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To devise a novel Ocular Anaesthetic Scoring System (OASS) as a quick means of assessing non-topical anaesthesia in cataract surgery. We also aim to analyse inter-observer consistency and determine how robust the test is. In addition we aim to use OASS to compare effectiveness of anaesthetic techniques and to determine whether this correlates with patient satisfaction.
In OASS a score between 0 (poor) and 14 (excellent) is obtained using objective (degree of ptosis, akinesia and orbicularis function) and subjective measures (digital spear pressure at limbus and topical anaesthetic sting). 100 patients were randomised to receive either sub-Tenon's (ST) or peribulbar (PB) block. The ST group was further divided into a low (150 units) or high (300 units) level of hyaluronidase group. Anaesthesia was assessed immediately preoperatively using OASS by two independent observers. Postoperative patient satisfaction was determined by Visual Analogue Pain Scale (VAPS) and Iowa Satisfaction with Anaesthesia Scale (ISAS). Statistical analysis was performed using non-parametric tests.
Two independent observers (an ophthalmologist and anaesthetist) obtained the same scores in 80% of cases and were within one point in all cases. Using OASS the ST approach achieved significantly better scores than the PB (P<0.001). Higher levels of hyaluronidase (300 units) were associated with significantly higher OASS scores (P<0.001). Spearman rank correlation showed that OASS correlates significantly with well-established subjective measures, VAPS (-0.60, p<0.0001) and ISAS (0.52, p<0.0001). The median satisfaction score was significantly higher in the ST than in the PB group and in the high level compared to the low level hyaluronidase group.
The newly devised OASS is a simple and robust test in assessing and comparing non-topical anaesthesia and techniques. We have shown that it correlates well with patient satisfaction studies. Of techniques used ST with higher dosage of hyaluronidase gave best results.
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