Randomized trial of superficial peribulbar compared with conventional peribulbar anesthesia for cataract extraction

Abdul Kader M Mahfouz^1,2, Hassan M Al Katheri²

¹Faculty of Medicine, Alexandria University, Egypt; ²Al Nahdha Hospital, Muscat, Sultanate of Oman.

Purpose: Evaluate efficacy of superficial peribulbar anesthesia for cataract extraction compared with conventional peribulbar anesthesia.

Setting: Department of Ophthalmology, Al Nahdha Hospital (Tertiary Ophthalmic and ENT Hospital) and Magraby Eye & Ear Center, Muscat, Sultanate of Oman.

Methods: Patients scheduled for cataract extraction with intraocular lens implantation were randomly divided into two groups according to anesthetic technique used. The first group patients were anesthetized using superficial peribulbar anesthesia, while second group patients were anesthetized using conventional peribulbar block. The efficacy of the blockade was judged by onset and degree of akinesia and volume of local anesthetic needed to obtain acceptable akinesia, sensation of pain during surgery, effect on intraocular pressure, degree of patient satisfaction, and incidence of complications.

Results: Nine hundred patients scheduled for cataract extraction with intraocular lens implantation during the period of June 2003 and October 2006 were included in this study. Five hundred cases were anesthetized using superficial peribulbar anesthesia and four hundred cases were anesthetized using conventional peribulbar block. The two groups were comparable as regards age, weight, gender, duration of surgery, and degree of analgesia. Superficial peribulbar anesthesia provided faster onset, higher degree of akinesia with less volume of local anesthetics used, no need for supplementary reinjection, no effect on intraocular pressure, and better patient satisfaction score compared with conventional peribulbar anesthesia. There were no serious complications in both groups. The incidence of subconjunctival hemorrhage was significantly higher in superficial peribulbar group (18%) compared with conventional peribulbar block (0.5%).

Conclusion: Superficial peribulbar anesthesia is a safe, simple, quick to perform, and effective method of anesthesia for cataract surgery with better patient satisfaction, better akinesia, and comparable analgesia compared with conventional peribulbar block. Subconjunctival hemorrhage is a self-limited complication associated with this technique.

Keywords: regional anesthesia, cataract surgery, peribulbar block.