Original ContributionsEvaluation of Anxiolysis and Pain Associated with Combined Peri- and Retrobulbar Eye Block for Cataract Surgery
Introduction
There is disagreement about the need for sedative or anxiolytic drugs to be given before peribulbar or retrobulbar injection of local anesthetic drugs in patients undergoing cataract surgery.[1] In some centers, it is customary to administer sedative doses of various intravenous (IV) anesthetic drugs before retrobulbar injection.[2] However, this practice has been criticized, particularly when used in elderly patients.[3] Campbell et al.[4] suggested a close correlation between pain and anxiety. Because retrobulbar injection with a 21-gauge or 23-gauge Atkinson needle is painful and uncomfortable,[2] sedation with short-acting IV anesthetic drugs before retrobulbar injection has been advocated.[2]
The goals of this study were (1) to evaluate the value of premedication with different anxiolytic drugs in reducing anxiety in patients undergoing cataract surgery with local anesthesia and (2) to quantify the pain associated with PRBB by comparing it with the relatively familiar pain associated with the placement of an IV cannula. A technique of painless PRBB is described, and the rationale for this technique is discussed.
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Materials and Methods
The protocol was approved by the Medi-Clinic Hospital Institutional Ethical Committee. All patients provided written informed consent.
A total of 376 adult ASA I and II patients presenting for cataract surgery with regional anesthesia were studied. On admission to the hospital, patients were extensively briefed by the nursing staff on the various procedures and asked if they required an anxiolytic drug; 240 patients (63.8%) requested anxiolytic therapy. These patients were then randomly
Results
The mean age of the study patients was 67.2 ± 12.5 years. There was no difference in the ages of the treatment groups (p >0.05). None of the patients were excluded from the study due to amnesia that could possibly have been caused by the benzodiazepine drugs, and oculocardiac reflex was not triggered in any of the patients. VAS values for anxiety at different stages of the procedure are summarized in Table 1.
In the six treatment groups (including the placebo group), anxiety decreased
Discussion
Anxiety and pain are subjective experiences and, as such, they are difficult to measure. By making use of the patient’s own perception, graded on a VAS, we could obtain anxiety and pain measurements to address the questions posed in this study. The VAS is a well accepted method of quantifying subjective perceptions for study purposes.12, 13, 14, 15 A further consideration in the design of the study was the fact that benzodiazepines might have had an anterograde amnesic effect on some of the
References (16)
- et al.
The effect of music on anxietyA research study
AORN J
(1989) The effect of humorous and musical distraction on preoperative anxiety
AORN J
(1995)- et al.
Assessment of preoperative anxietycomparison of measures in patients awaiting surgery for breast cancer
Br J Anaesth
(1995) - et al.
Limiting movement during retrobulbar block [Letter]
Anesth Analg
(1996) - et al.
Comparison of methohexital and alfentanil on movement during placement of retrobulbar nerve block
Anesth Analg
(1994) - et al.
Intravenous sedation for ocular surgery under local anaesthesia
Br J Ophthalmol
(1992) - et al.
Visual analogue measurement of pain
Ulster Med J
(1990) - et al.
Stressful pre-operative preparation proceduresThe routine removal of dentures during pre-operative preparation contributes to pre-operative distress
Anaesthesia
(1991)
Cited by (17)
Cataract in the Adult Eye Preferred Practice Pattern®
2017, OphthalmologyEye surgery in the elderly
2003, Best Practice and Research: Clinical AnaesthesiologyA comparison of propofol and remifentanil for sedation and limitation of movement during periretrobulbar block
2001, Journal of Clinical AnesthesiaTopical anesthesia versus retrobulbar block for cataract surgery: The patients' perspective
2000, Journal of Clinical Anesthesia
- 1
Senior Consultant, Department of Anesthesiology, University of Stellenbosch
- 2
Ophthalmologist
- 3
Registered Nurse, Medi-Clinic Hospital