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Meta-Analysis
. 2015 Jul 2;2015(7):CD004083.
doi: 10.1002/14651858.CD004083.pub3.

Peribulbar versus retrobulbar anaesthesia for cataract surgery

Mahmoud B Alhassan  1 , Fatima Kyari, Henry O D Ejere
Affiliations
Meta-Analysis

Peribulbar versus retrobulbar anaesthesia for cataract surgery

Mahmoud B Alhassan et al. Cochrane Database Syst Rev. .

Abstract

Background: Cataract is a major cause of blindness worldwide. Unless medically contraindicated, cataract surgery is usually performed under local (regional) anaesthesia. Local anaesthesia involves the blockage of a nerve subserving a given part of the body. It involves infiltration of the area around the nerve with local anaesthetic. The two main approaches in the eye are retrobulbar and peribulbar. There is debate over whether the peribulbar approach provides more effective, safer anaesthesia for cataract surgery than retrobulbar block.

Objectives: The objective of this review was to assess the effects of peribulbar anaesthesia (PB) compared to retrobulbar anaesthesia (RB) on pain scores, ocular akinesia, patient acceptability and ocular and systemic complications.

Search methods: In the previous version of our review, we searched the databases until December 2007. In this updated version, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (March 2015); MEDLINE (1960 to March 2015); and EMBASE (1980 to March 2015).

Selection criteria: We included randomized controlled clinical trials comparing peribulbar anaesthesia and retrobulbar anaesthesia for cataract surgery.

Data collection and analysis: Two authors independently assessed trial quality and extracted data. We contacted trial authors for additional information, study methodology and missing data. We carried out a descriptive narrative of results as the included studies used varied methods for reporting the outcomes. We performed a subgroup analysis for globe akinesia.

Main results: We included six trials involving 1438 participants. Three of the six trials had adequate sequence generation while all the trials had unclear allocation concealment There was no evidence of any difference in pain perception during surgery with either retrobulbar or peribulbar anaesthesia. Both were largely effective. There was no evidence of any difference in complete akinesia or the need for further injections of local anaesthetic. Conjunctival chemosis was more common after peribulbar block (relative risk (RR) 2.11, 95% confidence interval (CI) 1.46 to 3.05) and lid haematoma was more common after retrobulbar block (RR 0.36, 95% CI 0.15 to 0.88). Retrobulbar haemorrhage was uncommon and occurred only once, in a patient who had a retrobulbar block.

Authors' conclusions: There is little to choose between peribulbar and retrobulbar block in terms of anaesthesia and akinesia during surgery measuring acceptability to patients, need for additional injections and development of severe complications. Severe local or systemic complications were rare for both types of block.

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Conflict of interest statement

None known

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Peribulbar versus retrobulbar, Outcome 1 Pain score.
1.2
1.2. Analysis
Comparison 1 Peribulbar versus retrobulbar, Outcome 2 Globe akinesia.
1.3
1.3. Analysis
Comparison 1 Peribulbar versus retrobulbar, Outcome 3 Need for additional injection.
1.4
1.4. Analysis
Comparison 1 Peribulbar versus retrobulbar, Outcome 4 Local complications.
1.5
1.5. Analysis
Comparison 1 Peribulbar versus retrobulbar, Outcome 5 Acceptability of blocks.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Ali‐Melkkila 1992 {published data only}
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References to studies excluded from this review

Asensio 1994 {published data only}
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References to studies awaiting assessment

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References to other published versions of this review

Alhassan 2008
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