Pain induced by phacoemulsification without sedation using topical or peribulbar anesthesia

Purpose: To evaluate patient-reported pain induced by phacoemulsification without sedation using topical or peribulbar anesthesia. Setting: Department of Ophthalmology, School of Medicine of Ribeirão Preto, São Paulo, Brazil. Methods: This study assessed patient-perceived pain during phacoemulsification cataract surgery with peribulbar anesthesia (lidocaine 2%-bupivacaine 0.5% mixture) or with topical anesthesia (tetracaine drops); no patient received sedation. The same surgeon performed all surgeries using a clear corneal approach and in-the-bag intraocular lens implantation. Approximately 15 minutes after surgery, patients in the topical anesthesia group (n = 20) were asked to rate their pain during the procedure and patients in the peribulbar anesthesia group (n = 21), during infiltration of the anesthetic solution. Patients graded their pain using a 0- to 10-point visual analog scale (0 = no pain; 10 = unbearable pain). The results in the 2 groups were compared using the nonparametric Mann-Whitney U test. Results: The median pain score in the topical anesthesia group was 2 (range 0 to 5) and in the peribulbar anesthesia group, 3 (range 0 to 7). The mean rank in the topical anesthesia group (15.78) was significantly lower than the mean rank in the peribulbar anesthesia group (25.98) (P =. 0057, Mann-Whitney U test). Conclusion: In patients having phacoemulsification without sedation, those receiving peribulbar anesthesia reported more pain than those receiving topical anesthesia during anesthetic solution infiltration and during the procedure, respectively.