Topical Anesthesia vs. Peribulbar or Retrobulbar Blocks in Cataract Surgery
July 27, 2012
I still do peribulbar (actually, the anesthesiologist does it for me), so when i enter the O.R., the eye sees and feels nothing and doesn’t move. I don’t have to nag the patient to look anywhere, like my residents do. Of course, with coumadin cases, I’ll do topical or sub-Tenon’s. Anyway, a meta-analysis by Dr. Zhu in Ophthalmology showed that topical is more painful than retrobulbar (about equal to peribulbar) – BUT, they excluded those topical cases using intracameral lidocaine, so in my opinion, the study is fatally flawed for practical purposes.
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Comments
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I perform topical cataract surgery with intracameral lidocaine. I agree with you that it would be interesting to see the data comparing topical with lidocaine to injection anesthesia.
It’s completely anecdotal but my uncle had a couple of months of diplopia after cataract surgery with a block. He recovered completely but had difficulty when the diplopia was present. I know it’s a risk but don’t know the incidence.
Ultimately, we all want our patients to be as comfortable as possible during surgery.
yeah- diplopia is a very small risk. ive seen it a couple of times. it can be reduced even further by not using marcaine, but only lidocaine- seems the marcaine is toxic if injected into the extraocular muscle, but not lidocaine.