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A Journal on Ophthalmology
Minerva Oftalmologica 2013 March;55(1):7-16
Effectiveness of topical anesthesia versus local anesthesia to control intraoperative pain in patients subordinate to cataract emulsification
D’Agata S. 1, Garrino L. 2
1 Ricercatore in Scienze Infermieristiche Università degli Studi di Torino, Torino, Italia;
2 Infermiere, Presidio Ospedale Oftalmico ASLTO1, Torino, Italia
Aim: The aim of this paper was to establish the effectiveness of the topical anesthesia, a simple and easy technique, versus the traditional local anesthesia techniques in ophtalmology to control intraoperative pain in patients subordinate to cataract facoemulsification.
Methods: A review of the literature on Pubmed, Cochrane Library and Nice Guidelines is lead that has carried to the selection of 3 systematic reviews, 1 novellistic review, 8 RCT, 1 guideline.
Results: Topical anesthesia is an effective technique to reduce and control intraoperative pain in patients subordinates to cataract facoemulisification; its effectiveness is upgraded by the addition of anesthetic in the anterior chamber of the eye. However in trials in which the topical anesthesia is confronted with the local anesthesia in its several forms, it turns out to be less effective both in the reduction and in the control of intraoperative pain that in supplying a good degree of satisfaction of the patient. The topical anesthesia turns out to be instead painfuless in administration regarding the several local anesthesia techniques.
Conclusions: local anesthesia is more effective in the control of intraoperative pain regarding the topical anesthesia that cannot be used like practical routine; its employment must be classified to selected cases previous appraisal with the patient, the surgeon and the anesthetist. It is clear that, in more complex cases, subtenion anesthesia is the Gold Standard. A reflection is proposed on the effectiveness of pre and intraoperative counselling as a strategy to reduce the anxiety of the patients and to limit the use of oral and intravenous sedation.