Preemptive analgesia in elective cataract surgery (Phacoemulcification)

H Zahedi, Sh Arbabi, AE Soltany, M Nikoseresht


Background: Preemptive analgesia is based on the idea that analgesia which initiates before a nociceptive even will be
more effective than the analgesia commenced afterwards. This clinical trial compared postoperative analgesia and comfort in
patients with general anesthesia combined with preoperative or postoperative local anesthesia.
Methods: 90 patients who had been scheduled for phacoemulcification in Farabi Eye Hospital, 2002-3, were enrolled in the
study. Sixty patients received general anesthesia: 15 received preoperative local anesthesia (GA+LA+OP), 15 received postoperative
local anesthesia (GA+OP+LA), and 30 did not get local anesthesia (only GA). Thirty patients only received local
anesthesia (LA). Subjective postoperative pain was determined by a visual analogue scale. Frequency of oculocardiac reflex,
postoperative nausea and vomiting (PONV), and patient's comfort were assessed.
Results: Postoperative pain was less in local anesthesia (LA) compared to general anesthesia (GA) (p < 0.0001). Additional
preoperative application of local anesthesia (GA+LA+OP) resulted in less pain than additional postoperative application
(GA+OP+LA) (p <0.05). Additional postoperative peribulbar block did not differ from general anesthesia (Only GA). The
incidence of intraoperative oculocardiac reflex and postoperative nausea and vomiting was significantly less in patients with
peribulbar block (P = .0001) and in GA+LA+OP group, as compared with others (P= 0.001).
Conclusion: We conclude that preoperative local anesthesia (Only LA ) or in combination with general anesthesia provides
the best comfort for the patient in eye surgery.
Keywords: preemptive analgesia, analgesia, peribulbar block, postoperative pain, phacoemulcification, ocular surgery

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