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M.–H. Nghiem–Buffet, B. Sonigo, F. Fajnkuchen, G. Chaine; Topical versus Sub–Tenon’s Anesthesia Without Sedation in Clear Corneal Cataract Surgery . Invest. Ophthalmol. Vis. Sci. 2005;46(13):793.
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Purpose: To compare the effectiveness and pain control of topical versus sub–Tenon’s anesthesia for clear corneal phacoemulsification cataract surgery and foldable intraocular lens implantation. Methods: 91 consecutive patients who had cataract surgery with topical anesthesia (43 eyes) or sub–Tenon’s anesthesia (48 eyes) were prospectively analyzed. All patients had clear corneal phacoemulsifcation with foldable IOL implantation performed by three surgeons. Patients were asked to rate their pain level on a 10–point scale. Surgeons recorded their surgical observations (positive pressure, complications). Blood pressure was measured every 10 minutes during surgery. Results: Both groups were similar in age and sex. 44,2 % of the patients in the topical group and 45,8% of the sub–Tenon’s group were treated for arterial hypertension before surgery. The mean pain score was 1,88 +/– 2,7 (SD) in the topical group and 1,10 +/– 1,6 (SD) in the sub–Tenon’s group with no statistical significant difference. Arterial elevation of systolic blood pressure over 160mmHg was noted in 8 patients (18,6%) in the topical group and in 13 patients (27,1%) in the sub–Tenon’s group with no statistical significant difference. Positive pressure was observed in 3 eyes in the topical group and in 4 eyes in the sub–Tenon’s group. Pain score was not significantly higher in those cases. Only one patient with positive pressure showed a blood pressure elevation in the same time. Capsular rupture complication occurred in one eye in the topical group. Residents were implicated in the surgical procedure in 16 cases (37,2%) in the topical group and in 22 cases (45,8%) in the sub–Tenon’s group with no statistical significant difference. Conclusions: Patients having cataract surgery under topical anesthesia did not show more incidence of blood pressure elevation or positive pressure that patients receiving sub–Tenon’s anesthesia. Topical anesthesia is a safe method that provides approximately the same pain score that sub–Tenon’s anesthesia. Topical anesthesia can be used when resident teaching phacoemulsification.
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