new analgesia protocol for cataract surgery

Our objective was to describe the safety and efficacy of a new analgesia protocol that enables the surgeon to maintain control over an alert patient experiencing seemingly painless ambulatory cataract surgery, while eliminating the risks and side effects associated with general, local, and intracameral anesthesia. This study was carried out on two thousands cataract surgery cases. This technique produces profound ocular analgesia, avoiding any undesired sedative effects, using very low-dose, titrated, intravenous alfentanil. Complete control of the uncooperative patient, including lid squeezing and ocular and genera! body movements, is obtained whenever necessary using very low-dose, titrated, intravenous propofol. Success was defined as surgery completed in a controlled manner without the need to convert to general, local, or intracameral anesthesia and the patent's experience being perceived as pain free. One thousand nine hundred ninety-five [99.75%] of the cases were successful without ever deviating from the protocol. This analgesia protocol offers advantages for cataract surgery. It virtually eliminates the morbidity of cataract surgery associated with other anesthesia techniques while providing excellent and reliable control with minimal side effects. It allows for an immediate postoperative recovery with instantaneous vision restoration. These patients are generally awake, alert, and retain their protective reflexes

Safety and efficacy of intracameral injections of preservative - free lidocaine as an adjuvent to topical anesthesia to reduce intraocular sensation versus peribulbar anesthesia

This study was done to evaluate the efficacy and safety of intracameral lidocaine in cataract surgery compared to peribulbar anesthesia. This study was carried out on rabbits [n = 20] and patients [n = 160]. Our primary concern was the potential for corneal toxicity from the intracameral lidocaine. The preliminary study with rabbits showed no significant difference in corneal endothelial toxicity between the 20 rabbit eyes injected with 1% preservative-free lidocaine and the 20 eyes injected with BSS [p = 0.42]. As regards the human studies, a total of 160 cataract patients [160 eyes] participated. Eyes were classified to two groups: one group [n = 80] received 0.2 ml intracameral 1% unpreserved lidocaine combined with topical anesthesia [bupivacaine]; the other group [n = 80] received a peribulbar block with a sharp 26-gauge needle using a solution of lidocaine 2% [3 ml], bupivacaine 0.5% [2 ml], and hyaluronidase [wydase] 150 U before phacoemulsification with sclerocorneal tunnel incision .Duration of surgery was measured; implicit time and amplitudes of the b-waves of the photopic electroretinogram [ERG] potentials [single-flash ERG and the 30-Hz flicker ERG] were recorded; frequencies of intraoperative problems, complications, intraoperative, and postoperative pain were evaluated. Surgeon assessments of operative conditions and patient cooperation were recorded. The attending anesthesiologist recorded any increase in pulse or increase in blood pressure. After lidocaine anesthesia combined with topical anesthesia, similar complications were found, longer operation time [p < 0.001], and significantly better visual acuity immediately after surgery [p < 0.001]. The ERG amplitudes were not significantly reduced after 0.2 ml intracameral lidocaine half an hour after surgery [p > 0.05]. The surgeon assessment showed more patient cooperation in the peribulbar group [p = 0.012]. No patient in either group was rated as poorly cooperative. Intracameral lidocaine 1% combined with topical anesthesia can be recommended as an alternative procedure to peribulbar anesthesia in cataract surgery especially in the following situations: in patients with high myopia, fear of syringes, or prolonged coagulation