Topical and subconjunctival anesthesia for phacoemulsification: Prospective study

Purpose: To evaluate the efficacy and safety of topical and subconjunctival anesthesia for phacoemulsification and to compare the results with those of retrobulbar-peribulbar anesthesia. Methods: This prospective study evaluated 402 patients having phacoemulsification during 60 surgical sessions. Patients were randomly assigned to receive a topical and subconjunctival injection of lidocaine 4% or a retrobulbar injection of the same anesthetic. Results: Patients who received topical and subconjunctival anesthesia received less anesthetic (0.25 versus 3.25 mL) and had fewer side effects from the intravenous sedation and a lower incidence of capsular rupture associated with positive vitreous pressure during surgery (0 versus 2.9%). The difference in postoperative discomfort was not statistically significant, and there were no complications resulting from needle insertion. Conclusion: Topical and subconjunctival anesthesia using lidocaine 4% was as effective as retrobulbar and peribulbar anesthesia for routine phacoemulsification. In addition, fewer anesthetic drugs and less patient sedation were required, and there were fewer intraoperative and postoperative complications.