A new report prepared for the federal Agency for Healthcare Research and Quality (AHRQ) concludes that currently employed approaches to anesthesia management provide adequate pain control for successful cataract surgery. But the report by the Johns Hopkins University Evidence-based Practice Center also says that more data are needed on patient preferences and cost effectiveness to determine the optimal strategies for anesthesia management during cataract surgery.
Among the studyís findings are that topical anesthesia does not provide as complete pain control as do the various injection techniques, although topical anesthesia is clearly quite effective and avoids the rare complications potentially associated with injection techniques. The literature provides strong evidence that peribulbar and retrobulbar blocks perform similarly. Another common technique, sub-Tenonís block, also appears to be at least as effective in pain control as the other block techniques, and to be less painful. Regional blocks using needles have a small but definite risk of major complications, including globe perforation and retrobulbar hemorrhage. There is only weak evidence that intravenous or intramuscular sedation or analgesia improve anxiety control, pain relief, and patient satisfaction with cataract surgery.
Other findings include that:
- Having an anesthesiologist or other anesthesia provider present for every case of cataract surgery is associated with increased costs but clinicians express a preference for it. However, additional data are needed on clinician and patient preferences to determine the cost-effectiveness of this practice.
- Cataract surgery patients have a high level of satisfaction with anesthesia management regardless of the strategy used.
- Patients receiving intravenous sedation have a higher rate of postoperative nausea and drowsiness than patients not receiving these agents.
Medicare beneficiaries undergo approximately 1.6 million operations a year for age-related cataract, almost always as an outpatient procedure. Cataract patients are usually given a local anesthetic prior to surgery in addition to systemic sedation administered by an anesthesiologist or a nurse anesthetist. However, previous research has found substantial national and international variation in anesthesia management strategies for cataract surgery. The preferences of surgeons and anesthesia providers, along with the characteristics of cataract patients, are believed to influence the types and administration of anesthesia. But there is uncertainty as to which strategy or strategies provide the best mix of patient comfort, desirable outcomes such as pain control, and freedom from anesthesia-related complications.
The summary of Evidence Report Number 16, Anesthesia Management During Cataract Surgery, is available online at http://www.ahrq.gov/clinic/anestsum.htm. Printed copies are available from the AHRQ Publications Clearinghouse by writing to P.O. Box 8547, Silver Spring, MD 20907, or calling (800)-358-9295 within the United States, or (410) 381-3150 from outside the country. Copies of the full report are expected to be available from the AHRQ Clearinghouse in late 2000.
For more information, please contact AHRQ Public Affairs, (301) 594-1364: Robert Isquith, (301) 594-6394 (RIsquith@ahrq.gov).