RESUMO
This is a prospective randomized comparative blind study designed to compare perioperative pain control, complications and efficacy of sub-tenon's anesthesia versus topical anesthesia in corneal phacoemulsification surgery and foldable intraocular lens [IOL] implantation in complicated patients. Ninety-eight patients were allocated randomly to either sub-tenon's or topical group with preset criteria after obtaining a written informed consent. All surgeries were preformed by one surgeon. Perioperative pain was assessed using a visual analog pain scale [VAS] and compared for both techniques, anesthesia related events and complications together with intraoperative surgical complications were compared. Visual experience of patients during phacoemulsification cataract surgery was assessed; patient as well as surgeon satisfaction was also noted. Ninety seven out of ninety eight patients completed study after exclusion of one case. The data of the two groups were comparable in terms of age, sex, ASA [American Society of anesthesiologists] state, axial length of the eye and duration of surgery. There were no statistical differences between the 2 study groups in the preoperative eye complications. Forty five patients out of 49 patients in tenon's anesthesia group and four patients out of 48 in subtenon's aesthesia group experienced no pain during administration of anesthesia p<0.001. There was significant difference in pain intensity during surgery, immediately and 3 h after surgery p<0.05. Sub-tenon group had significantly more anesthesia related complications than topical anesthesia group p<0.05. There was no significant difference in the intraoperative complications between the two groups under study. About 16 patients of the sub-tenon's group had absolute akinesia during surgery as compared to none in topical group p<0.001. Topical anesthesia appears to result in greater visual awareness than sub-tenon's block p= 0.012. Sub-tenon's block was found satisfactory by 46 patients of cases and they would choose the same anaesthesia for another procedure while thirty two patients of patients subjected to topical anesthesia were satisfied p<0.001. Surgical conditions were graded to be optimal by the surgeon [none-minimal difficulties] in 46 patients subjected to sub-tenon's block and in 32 patients subjected to topical anesthesia p<0.001. In complicated cataract cases undergoing corneal phacoemulsification and foldable lens implantation, sub-tenon's anesthesia was superior to topical anesthesia. Our results showed that more significant anesthesia and analgesia was achieved with the sub-tenon's block anesthesia, led to more convenient surgical conditions and enhanced patient and surgeon satisfaction without compromising patient's safety