Sarcouncil Journal of Medical Sciences

Abstract: Background & Aim: Phacoemulsification is the standard of cataract surgery, but the best anesthesia method is controversial, which topical anesthesia is the least invasive, however, it can jeopardize ocular akinesia whereas retrobulbar anesthesia has deep blockade although it is more invasive, where this study aimed determine the clinical efficacy, hemodynamic stability, length of surgery, perception of pain, cooperation of the patient, and complication between topical plus intracameral anesthesia and retrobulbar anesthesia in phacoemulsification. Methodology: A comparative clinical trial was done on 176 patients undergoing phacoemulsification, divided into Group 1 (n=100) with topical anesthesia and Group 2 (n=76) with retrobulbar anesthesia. Information gathered was demographic and clinical characteristics, pre- and post-operative blood pressure (BP) and intraocular pressure (IOP), surgical duration (before and after placement of the speculum), intraoperative and postoperative pain scores, patient cooperation, inadvertent eye movements, need of supplemental anesthesia, and anesthesia/intraoperative complications. Findings: Demographic and preoperative BP and initial IOP did not differ between groups. Group 1 showed much shorter surgical times pre- (7.33 vs 8.85 min) and post-speculum insertion (18.57 vs 20.53 min). In Group 1, patient cooperation was significantly improved, and the inadvertent eye movement was much lower (0.02 vs. 0.25). Owing to the Group 1 (2.0% vs. 31.6%), the need of additional anesthesia was significantly minimized. Intra and post-operative pain scores, postoperative hemodynamic changes, and IOP changes were statistically equal between groups. Conclusion: The two anesthetic methods are both safe and effective methods of analgesia in phacoemulsification, with similar pain control and stable hemodynamics. But the method used in Group 1 produces far better intraoperative results, such as a greater improvement in ocular akinesia and greater patient cooperation, shorter operative time, and a much-reduced need of supplemental anesthesia. These findings indicate that the technique of Group 1 could be a better choice when the precision and stability of surgical procedures are prioritized, and both procedures are accepted clinically, depending on the choices of the patient and the surgeon.