Pain in scleral pocket incision cataract surgery using topical and peribulbar anesthesia

Purpose: To evaluate the pain produced during different phases of phacoemulsification cataract surgery using a scleral pocket incision under topical versus peribulbar anesthesia. Setting: Department of Ophthalmology, Oulu University Hospital, Oulu, Finland. Methods: This prospective study comprised 100 cataract patients who were randomly selected to have phacoemulsification with a scleral pocket incision using either topical or peribulbar anesthesia. Topical anesthesia comprised oxybuprocaine 0.4% drops. Peribulbar anesthesia was given with an inferolateral transconjuctival injection of an even mixture of lidocaine 2% and bupivacaine 0.5% with hyaluronidase. Inadvertent eye movement during surgery was recorded. Pain occurring during intravenous line cannulation, introduction of the anesthestic agent, and phacoemulsification was measured using a visual analog scale (from 0 to 10) and a descriptive verbal 5-step scale. Patients were asked about pain immediately after each phase. Results: The pain during cannulation was similar in both groups (P =.498). The peribulbar injection was statistically significantly more painful than induction of topical anesthesia (2.11 and 0.10, respectively; P <.001). Surgery was statistically significantly more painful in the topical group than in the peribulbar group (2.76 and 0.85, respectively; P <.001). The mean pain score during all 3 phases was similar (1.43 topical group and 1.51 peribulbar group; P =.500). On the verbal scale, surgery was more painful under topical than under peribulbar anesthesia (P<.001). There were no statistical differences in pain during the peribulbar injection and during cannulation (P =.461 and P =.462, respectively). Inadvertent eye movement occurred more often in the topical anesthesia group. Conclusion: Considering the entire procedure, total pain using topical anesthesia was acceptable and equal to that using peribulbar anesthesia for phacoemulsification with a scleral pocket incision. Pain during phacoemulsification was greater under topical anesthesia but not significantly different from the pain during the peribulbar injection.