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COCHRANE CORNER

Sub-Tenon’s Anesthesia Versus Topical Anesthesia for Cataract Surgery

BACKGROUND:

Local anesthesia for cataract surgery can be provided by either sub-Tenon or topical anesthesia. Although there is some work suggesting advantages to both techniques, there has been no recent systematic attempt to compare both techniques for all relevant outcomes.

OBJECTIVES:

We compared the effectiveness of topical anesthesia (with or without the addition of intracameral local anesthetic) and sub-Tenon’s anesthesia for providing pain relief during cataract surgery.

SEARCH STRATEGY:

We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2006, Issue 2); MEDLINE (1990 to July 2006); EMBASE (1990 to July 2006), and reference lists of articles. There were no constraints based on language or publication status.

SELECTION CRITERIA:

We included all randomized or quasirandomized studies comparing sub-Tenon anesthesia with topical anesthesia for cataract surgery.

DATA COLLECTION AND ANALYSIS:

Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We also collected adverse effects information from the trials.

MAIN RESULTS:

Seven studies involving 617 patients with 742 eyes operated on were examined. Five studies used unpaired data, with a single eye operated on; two studies used paired data with both eyes operated on. The surgical technique was clear corneal incision in five studies and scleral tunnel in two. The overall quality of the studies was not high, with one study triple-blind (patient, surgeon, and assessor blinded to treatment group) and three others single-blind. The allocation of concealment and methods of randomization were only described in two studies. Three unpaired studies showed that sub-Tenon anesthesia provided better intraoperative pain relief than topical anesthesia (pooled weighted mean difference [fixed] 1.28, 95% CI: 0.83–1.72). The differences in the pain scores were not necessarily clinically significant although they were statistically significant. The differences were not large in magnitude and are skewed to the low end of the visual analog scale, but the studies are consistent throughout in reporting more pain in the topical anesthesia group. This was also supported by the one paired study which showed that the mean pain score in the topical group was 1.13 (sd: 1.57) compared with 0.57 (sd: 1.28) in the sub-Tenon group (P < 0.001). Three of the studies used a 10-point visual analog scale, whereas one used a novel five-point scale. Further support was provided by other outcome measures. Sub-Tenon anesthesia caused more chemosis and subconjunctival hemorrhage although this was purely esthetic. The more serious complication of posterior capsule tear and vitreous loss occurred twice as much in the topical group than with sub-Tenon anesthesia (4.3% vs 2.1%).

REVIEWER’S CONCLUSIONS:

Sub-Tenon anesthesia provides better pain relief than topical anesthesia for cataract surgery.

CITATION:

Davison M, Padroni S, Bunce C, Rüschen H. Sub-Tenon’s anesthesia versus topical anesthesia for cataract surgery. The Cochrane Database of Systematic Reviews, 2007, Issue 3: CD006291. Copyright© 2005. The Cochrane Collaboration. Reproduced with permission.

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