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Outcomes/Effectiveness Research

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Pain during cataract surgery and postoperative side effects are minor for most patients but vary by type of anesthesia

From the perspective of patients undergoing cataract surgery, several anesthesia strategies are highly effective for reducing the pain of surgery. Which one works best depends on patient perceptions. For example, some patients may prefer intraoperative sedatives, despite their greater risk of postoperative nausea. Although minimizing patient reports of pain and side effects is important, there are tradeoffs between the patient, surgeon, and anesthesiologist to choose the appropriate pain control strategy for an individual patient, explains Oliver D. Schein, M.D., M.P.H., of the Johns Hopkins University School of Medicine.

In a recent study supported by the Agency for Healthcare Research and Quality (HS08331), Dr. Schein and his colleagues compared patient reports of intraoperative pain and postoperative side effects (drowsiness, nausea, and vomiting) for different anesthesia strategies for cataract surgery. They analyzed 19,250 cataract surgeries performed at nine centers in the United States and Canada from 1995 to 1997. The strategies included topical anesthesia or anesthesia with injection, with or without sedatives, opioid analgesia, hypnotics, and diphenhydramine (Benadryl). Topical anesthesia was associated with more pain during cataract surgery than injected anesthesia. Patients receiving injected anesthesia varied in their reporting of pain during surgery and side effects, depending on the types of medications used.

Local anesthesia by injection with sedatives and diphenhydramine resulted in the lowest reporting of any intraoperative pain (1.3 percent). Postoperative drowsiness (9.6 percent) and nausea, vomiting, or both (1.5 percent), was comparable to topical anesthesia alone. Among those receiving topical anesthesia, the use of sedatives and opioids reduced reports of any pain during surgery by 56 percent but more than doubled the rates of nausea and vomiting (odds ratio, 2.27) compared with patients who received topical anesthesia alone, after adjusting for age, sex, race, risk class, health status, and duration of surgery.

See "Injectable versus topical anesthesia for cataract surgery: Patient perceptions of pain and side effects," by Joanne Katz, Sc.D., Marc A. Feldman, M.D., M.H.S., Eric B. Bass, M.D., M.P.H., and others, in the November 2000 Ophthalmology 107(11), pp. 2054-2060.

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