A Safe, Efficacious and Cost Effective Way of Delivering Sub-Tenon’s Anaesthesia during Cataract Surgery

Abstract

Aims: There are considerable pressures in various health economies at present to reduce costs whilst maintaining patient safety and clinical efficacy. We report a new simplified regime for the administration of Sub-Tenon’s anaesthesia offering a cost saving of up to 95% whilst maintaining to total safety and efficacy. Study Design: The study compared usage of 2% Xylocaine (2% Lignocaine with 1:200000 Adrenaline) over the more prevalent regime of 2% Bupivacaine + 2% Lignocaine + Hyaluronidase in terms of cost, patient satisfaction, safety and efficacy prior to phacoemulsification surgery. Place and Duration of Study Sample: Department of Ophthalmology, Royal Preston Hospital, Preston UK between July and November 2010. Methodology: Following topical anaesthesia with 3 drops of Proxymetacaine 0.5% drops instilled one minute apart and subsequent administration of a drop of 5% Povidone Iodine aqueous solution into the conjunctival sac, 2ml of 2% Lignocaine with 1:200000 adrenaline was administered as a Sub-Tenon’s injection to 100 eyes of consecutive patients undergoing phacoemulsification. Pain levels during the administration of the injection and during surgery were monitored by measuring Visual Analogue Pain (VAP) scores via a prospective questionnaire immediately after the operation. Results: There were 100 eyes of patients undergoing cataract surgery included in this study. No patient required top up anaesthesia during the surgery and no serious anaesthetic related intra or post-operative complication was noted in any of the patients. The mean VAP score during delivery of anaesthetic and for the duration of surgery were both 0. Conclusion: Our results show that this regime for administration of Sub-Tenon’s anaesthesia meets the standards required in terms of both safety and efficacy whilst delivering considerable cost savings. We recommend its routine use for the reasons cited above.