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Meta-Analysis
. 2015 Aug 27;2015(8):CD006291.
doi: 10.1002/14651858.CD006291.pub3.

Sub-Tenon's anaesthesia versus topical anaesthesia for cataract surgery

Joanne Guay  1 , Karl Sales
Affiliations
Meta-Analysis

Sub-Tenon's anaesthesia versus topical anaesthesia for cataract surgery

Joanne Guay et al. Cochrane Database Syst Rev. .

Abstract

Background: Local anaesthesia for cataract surgery can be provided by sub-Tenon's or topical anaesthesia. Both techniques offer possible advantages. This review, which originally was published in 2007 and was updated in 2014, was undertaken to compare these two anaesthetic techniques.

Objectives: Our objectives were to compare the effectiveness of topical anaesthesia (with or without intracameral local anaesthetic) versus sub-Tenon's anaesthesia in providing pain relief during cataract surgery. We reviewed pain during administration of anaesthesia, postoperative pain, surgical satisfaction with operating conditions and patient satisfaction with pain relief provided, and we looked at associated complications.

Search methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE (last search in November 2014) and the reference lists of published articles. We looked for conferences abstracts and trials in progress and placed no constraints on language or publication status.

Selection criteria: We included all randomized studies that compared sub-Tenon's anaesthesia versus topical anaesthesia for cataract surgery.

Data collection and analysis: We assessed trial quality and extracted data in the format allowing maximal data inclusion.

Main results: We included eight studies in this updated review but could retain in the analysis only seven studies on 742 operated eyes of 617 participants. Two cross-over trials included 125 participants, and five parallel trials included 492 participants. These studies were published between 1997 and 2005. The mean age of participants varied from 71.5 years to 83.5 years. The female proportion of participants varied from 54% to 76%. Compared with sub-Tenon's anaesthesia, topical anaesthesia (with or without intracameral injection) for cataract surgery increases intraoperative pain but decreases postoperative pain at 24 hours. The amplitude of the effect (equivalent to 1.1 on a score from 0 to 10 for intraoperative pain, and to 0.2 on the same scale for postoperative pain at 24 hours), although statistically significant, was probably too small to be of clinical relevance. The quality of the evidence was rated as high for intraoperative pain and moderate for pain at 24 hours. We did find differences in pain during administration of local anaesthetic (low level of evidence), and indications that surgeon satisfaction (low level of evidence) and participant satisfaction (moderate level of evidence) were less with topical anaesthesia. There was not enough evidence to say that one technique would result in a higher or lower incidence of intraoperative complications compared with the other.

Authors' conclusions: Both topical anaesthesia and sub-Tenon's anaesthesia are accepted and safe methods of providing anaesthesia for cataract surgery. An acceptable degree of intraoperative discomfort has to be expected with either of these techniques. Randomized controlled trials on the effects of various strategies to prevent intraoperative pain during cataract surgery could prove useful.

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Conflict of interest statement

Joanne Guay: I have had no direct relationship with any pharmaceutical company or equipment manufacturer in the past five years. I have not acted as a witness expert in the past five years. I am not an author of any of the included or excluded studies. I do not hold stock other than mutual funds. During the past five years, I have received fees as speaker for two lectures given at the University of Dalhousie: one on regional anaesthesia for carotid endarterectomy, and the other on local anaesthetic‐related methaemoglobinaemia. My fees were paid by the University of Dalhousie. I am the editor of a multi‐author textbook on anaesthesia (including notions on general and regional anaesthesia). I receive fees for a course on airway management from University of Quebec in Abitibi‐Temiscamingue.

Karl Sales: I have had no direct relationship with any pharmaceutical company or equipment manufacturer in the past five years. I have not acted as a witness expert in the past five years. I am not an author of any of the included or excluded studies.

Figures

1
1
Flow diagram of study selection for the updated review.
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 Topical anaesthesia versus sub‐Tenon's anaesthesia, Outcome 1 Pain during surgery.
1.2
1.2. Analysis
Comparison 1 Topical anaesthesia versus sub‐Tenon's anaesthesia, Outcome 2 Pain during anaesthesia administration.
1.3
1.3. Analysis
Comparison 1 Topical anaesthesia versus sub‐Tenon's anaesthesia, Outcome 3 Pain at 30 minutes after surgery.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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NCT01344252 {published data only}
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