The Comparison of Post-Operative Pain between Topical Anesthesia and Monitored Anesthesia Care in Cataract Surgery

ABSTRACT

PURPOSE: To compare pain levels in cataract surgery under topical anesthesia only and topical anesthesia under monitored anesthesia care. METHODS: We recruited 243 patients who were scheduled to undergo cataract surgery under topical anesthesia only or topical anesthesia with monitored anesthesia care (MAC) using fentanyl and midazolam. Anesthesia methods were selected based on the patient's preference. All patients completed an anxiety and information scale survey preoperatively. Vital signs during the operations were recorded. A 0-to-10 visual analog scale pain score survey was conducted immediately and at 2 hours, 6 hours, and 1 day after surgery. RESULTS: Of the 237 patients who completed the study, 183 patients selected topical anesthesia, and 54 patients selected MAC. Mean pain scores according to the aforementioned time points after surgery were 0.50, 0.58, 0.29, and 0.12 in the topical anesthesia group, and 0.22, 0.16, 0.06, and 0.09 in the MAC group, respectively. The differences in pain score between the two groups was statistically significant at 2 hours (p = 0.019) and 6 hours (p = 0.040) after surgery. The mean patient anxiety score for anesthesia was 10.50 in the topical anesthesia group and 11.41 in the MAC group (p = 0.280). Mean systolic blood pressure at the start of surgery was 140.6 mm Hg in the topical anesthesia group, and 158.2 mmHg in the MAC group. CONCLUSIONS: Monitored anesthesia care consistently resulted in less pain throughout the post-operative period. However, transient systolic blood pressure should be carefully monitored for a rise related to intravenous anesthetics.