COMPARISON OF EFFICACY AND SAFETY OF SUBTENON’S ANAESTHESIA WITH AND WITHOUT HYALURONIDASE IN BILATERAL CATARACT PATIENTS

Abstract

Ocular anaesthesia is the first step in cataract surgery and several techniques were discovered and being used . Subtenon’s block ; one of the technique of anaesthesia helps in an uneventful cataract surgery and better surgeons comfort and satisfaction. The effect of subtenon’s block with the usage of hyaluronidase in terms of analgesia and akinesia was studied in different sets of people and the results were not satisfactory in all of them .This study is about the comparison of efficacy of subtenon’s anaesthesia with and without hyaluronidase in the same individual with operable cataract in both the eyes which eliminates bias and mitigates the confounding factors such as age, sex, pain threshold of a person , anatomical variations when done on different individuals. AIMS AND OBJECTIVES To evaluate the efficacy of subtenon’s anaesthesia with hyaluronidase in group A patients and without hyaluronidase in group B undergoing cataract surgery in terms of  Globe akinesia  Lid akinesia  Analgesia  Onset and duration of anaesthesia intra operatively To document complications related to subtenon’s anaesthesia . xi MATERIALS AND METHODS A total of 39 patients (78 eyes) who fulfill inclusion criteria were selected and subtenon’s anaesthesia with hyaluronidase was used during the first eye cataract surgery followed by the other eye one month later where subtenon’s anaesthesia without hyaluronidase was adopted. In both groups Analgesia was graded between 0-4 grades and globe akinesia was graded between 0- 3 grades and lid movements was graded between 0-2 grades. RESULTS Analgesia (p = 0.008), globe akinesia (p = 0.002)at 15 mins ,lid akinesia (p=0.027) at 10 mins were good in Group A and it was statistically significant. The rate of onset of akinesia , patient and surgeon satisfaction were better in case of Group A . Complications were equal in both the groups showing no role of hyaluronidase in the complications and relating them to subtenon’s . CONCLUSION Hyaluronidase has shown better onset of akinesia, good intraoperative analgesia , good globe and lid akinesia .The patient and surgeons satisfaction in the hyaluronidase group was better compared with the non hyaluronidase group. In the busy schedule of cataract surgery where the surgeon has to operate many cases in a single day a earlier onset of anesthesia will minimize the time required for the completion of the surgery on a whole and save more time. And also pain being less in the hyaluronidase group will lead to more comfort of the patient.