Effects of Adding Subconjunctival Block to Intravenous Sedation and Topical Anesthesia for Phacoemulsification Surgery on Intraoperative Pain, Patient Cooperation, and Patient and Surgeon Satisfaction



Soltani HA¹ ; Dehghan AR² ; Mousavifard SN³ Show Affiliations
Source: Journal of Isfahan Medical School Published:2013

Abstract

Background: Subconjunctival block (SCB) had been reported to be useful for strabismus surgery, laser cyclophotocoagulation, and glaucoma surgery. The aim of this study was to evaluate the efficacy of adding SCB to intravenous sedation and topical anesthesia for phacoemulsification surgery. Methods: After the approval from the institutional ethics committee and obtaining written consents from the patients, 64 adults scheduled for phacoemulsification were enrolled in this double-blind clinical trial. The subjects were randomly allocated to two equal groups of case and control. All patients received similar preoperative preparation, intravenous sedation (1.5 μg/kg fentanyl and 0.15 mg/kg ketamine), and topical anesthesia (0.05% tetracaine) before surgery. Intraoperative additional fentanyl and ketamine was administered as needed. The cases received SCB with 0.1 ml of bupivacaine 0.5% at the site of incision. The controls received equal volume of balanced salt solution. Patient cooperation and satisfaction, severity of intraoperative pain, additional drug requirement, postoperative nausea and vomiting, recovery time and surgeon satisfaction were determined and recorded. Data was analyzed using t-test, and chi-square, Fisher's exact, and Mann-Whitney tests. P < 0.05 was considered significant. Findings: Demographic data was similar in the two groups. The frequency of excellent patient satisfaction was 28 (87.5%) in the case group and 15 (46.9%) in the control group. The corresponding values were 25 (78.1%) and 18 (56.3%) for patient cooperation and 24 (75.0%) and 19 (59.4%) for surgeon satisfaction (P < 0.05). Intraoperative additional fentanyl requirement, intra- and postoperative severity of pain, and recovery time were significantly lower in the case group than in the control group. Conclusion: This study showed that adding subconjunctival block to intravenous sedation and topical anesthesia in phacoemulsification surgery may enhance patients' comfort and the conditions of the operation.