M A Y 2 0 1 6 • O U T PA T I E N T S U R G E R Y. N E T • 3 1
Topical or Block: What's Best for Cataracts?
Factors to consider before you choose one method over another.
W
hat's the best way to anesthetize cataract patients — topical anesthesia
or nerve blocks? Regardless of your preference, intravenous sedation
given beforehand helps reduce anxiety and keep patients comfortable. It
also helps patients hold relatively still, as long as you don't administer too large of a
dose. Administer too much and patients may fall asleep and either snore — moving
their heads slightly when they do — or suddenly wake up and jerk their heads,
momentarily unaware of their whereabouts. Beyond that, the topical block debate
depends on several factors. Let's look at some of the considerations.
Is eye movement OK?
If you choose topical anesthesia, patients will be able to move their eyes, which is fine
as far as many surgeons are concerned. The key is that those patients are properly
sedated and comfortable. But if you use topical without sedation, you may need to
supplement it with an intracameral injection of bupivacaine — an injection within the
anterior chamber of the eye. Typically, that's enough to keep patients comfortable,
because the procedure will likely be completed well before the anesthetic wears off.
Anesthesia Alert
Perry Ruspantine, CRNA, APRN
• TOPICAL VS. BLOCK With topical anesthesia (left), patients should be sedated enough that they feel comfortable and relaxed, but not
so sedated that they fall asleep. While blocks (right) have a higher risk for complications, some surgeons still feel they're safer overall.
Pamela
Bevelhymer,
RN,
BSN
