Injectable versus topical anesthesia for cataract surgery: patient perceptions of pain and side effects. The Study of Medical Testing for Cataract Surgery study team.

Cataract Surgery: A Journey Through the Lens of Pain Management

Cataract surgery is a common procedure, but the choice of anesthesia can significantly impact the patient's experience. This study investigated patient perceptions of intraoperative pain and postoperative side effects associated with different anesthesia strategies for cataract surgery.

The study, conducted at nine centers in the US and Canada, enrolled 19,250 patients undergoing cataract surgery. Patients received either topical anesthesia or anesthesia with injection, with or without sedatives, opioid analgesia, hypnotics, and diphenhydramine. The study focused on patient ratings of intraoperative pain, satisfaction with pain management, and early postoperative side effects, such as drowsiness, nausea, and vomiting.

The study found that 26% of surgeries were performed using topical anesthesia alone, while the remainder utilized peribulbar, retrobulbar, or facial nerve block, or a combination of these. Local anesthesia by injection with sedatives and diphenhydramine resulted in the lowest reporting of any intraoperative pain. Postoperative drowsiness and nausea/vomiting were comparable to those administered topical anesthesia alone. Among those receiving topical anesthesia, using sedatives and opioids reduced pain reports by 56%, but also increased nausea and vomiting. Opioids reduced pain among those receiving sedatives with injections, but did not increase postoperative side effects. Diphenhydramine also significantly reduced pain and side effects. The use of hypnotics with sedatives was associated with increased reports of pain during surgery and increased nausea and vomiting after surgery.

Anesthesia: Navigating the Path to a Comfortable Procedure

The study demonstrates that patient reports of intraoperative pain and postoperative side effects are generally low but vary considerably based on the anesthesia strategy employed. This research provides valuable information for ophthalmologists to guide their anesthesia choices and minimize patient discomfort.

The Lens of Patient Experience

The study emphasizes the importance of considering patient preferences and perceptions when deciding on anesthesia for cataract surgery. It highlights the value of offering a range of options to address individual needs and concerns. This research underscores the importance of patient-centered care and tailoring treatment approaches to optimize patient comfort and satisfaction.

Dr. Camel's Conclusion

This study reminds us that even a seemingly simple procedure like cataract surgery can have varying levels of comfort depending on the anesthesia used. Like a skilled desert guide, ophthalmologists must carefully consider the needs of each patient and choose the appropriate anesthesia strategy to ensure a smooth and comfortable journey through the procedure.