|Year : 1971 | Volume
| Issue : 1 | Page : 24-26
Local anesthesia in cataract surgery
SP Mathur1, RL Agarwal2, Sudama1
1 Department of Ophthalmology, J. L. N. Medical College, Ajmer, India
2 Department of Ophthalmology, R. N. T. Medical College, Udaipur, India
S P Mathur
Department of Ophthalmology, J. L. N. Medical College, Ajmer
Source of Support: None, Conflict of Interest: None
|How to cite this article:
Mathur S P, Agarwal R L, Sudama. Local anesthesia in cataract surgery. Indian J Ophthalmol 1971;19:24-6
For cataract axtraction an average Indian patient (a peasant) prefers cold weather as it is more congenial to stay in the hospital, and there is comparative lull in agriculture. Hence during this short period most of the ophthalmic surgeons find a large number of patients and the time that can be devoted to each operation is rather short. Local anesthesia is therefore the only method of choice. Some complications are however associated with this; (1) abrasion of the corneal epithelium when topical drops of anesthetic are put serval times, leading to pain and discomfort in the postoperative period; (2) a sense of heaviness or fulness of the orbit in case of nerve block, specially if these injections are repeated just before the operation.
In absence of any comparative data it was decided to undertake a study to evaluate the various methods of anesthesia to determine a procedure which is safely effective, introducing profound enough anesthesia which tasts for a reasonably sufficient length of time, and simultaneously ensures the prevention of any complication or untoward effect.
| Method and Material
The following procedures of local anesthesia were adopted routinely without any selection in 100 cases each.
| Topical Anesthesia
(a) Lignocaine 4 % solution dropped 4 times at intervals of 4 minutes in conjunctival sac.
(b) Lignocaine 2 % Jelly (water soluable) one bead placed in the conjunctival sac and the eye kept shut for 2 minutes.
| Nerve Block
(a) Facial nerve block: 4 cc of 2 % or 4% solution with adrenalin was injected (i) around the neck of the mandible (0'Brien's method) (ii) subcutaneously in the temporal area near the lateral canthus (Van-Lints method). Anesthesia was considered effective when patient asked to squeeze his eyelids every 5 minutes could not do so.
(b) Retrobulbar or ciliary ganglion block: 1,5 cc of 2% or 4% solution of lignocaine with adrenaline injected in retrobulbar region near the ciliary ganglion.
The effect was measured by the fall in intra-ocular tension recorded by a doctor other than the one who gave the injection in order to eliminate the possibility of a bias in favour of 4 % or 2 % solutions.
Care was taken not to inject more than 6 cc of 4% lignocaine solution with adrenline in a patient (the maximum doze recommended is 10 cc.)
The results are recorded in the following tables:
It is evident that as topical anesthesia lignocaine jelly gave better results in comparision with 4 lignocaine solution. The jelly was put in 2 minutes before the operation, and by the time facial and retro-bulbar injections were given, its action was complete. Even if the eye was kept open for a longer period after application of jelly, deepithelialisation of cornea never occured. This complication was present in 3% - 4% cases where lignocaine drops were used. With the jelly it was rather unsightly when it overflowed the lid down the cheek. This was avoided by fitting a thinner nozzle to the jelly tube and thus putting in a smaller amount. The anesthetic effect of jelly was more profound, and it was not necessary to repeat as was the case with drops. Looking into the case of applications and more profound action we have started using lignocaine jelly as a routine in every ophthalmic operation. It is also used for anesthesia for measuring intraocular tension by Schiotz tonometer. The jelly being water soluable, very soon disappred from the corneal surface. To avoid any chance of jelly seeping into the tonometer, we wash the eye with a few drops of normal saline. After tonometry liquid paraffin or ointment is not applied, and not a single case of de-epithelialisation of the cornea was seen.
Regarding the use of a 4 per cent Lignocaine solution for facial and ciliary block, it was seen that the effect was more profound and more lasting as compared to the injection of the conventional 2% solution. Precaution was taken that the 40% solution was injected with adrenalin, and never more than 6 cc. for a patient, 10 cc. being the maximum recommended dose. For the facial block it was noticed that O'Brien's method (injection near the neck of the mandible) gave better result as compared to Van-Lint's method; on an average the action lasted for one hour when a 4°%o solution was injected, which is double of that when the same quantity of a 2% solution is injected. The prolonged post-operative effect is decidely beneficial. In retrobulbar cilary block the action was doubly more profound when a 4 per cent lignocaine solution was used as compared to a 2 % solution, the quantity injected being 1.5 cc. in each case.
The work was done at the Department of Ophthalmology R. N. T. Medical College, Udaipur.
[Table - 1], [Table - 2], [Table - 3]