Valizadeh Ghazal, Duong Elliot, Thang Christopher, White Leigh D
Department of Ophthalmology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.
Clin Ophthalmol. 2025 May 2;19:1475-1487. doi: 10.2147/OPTH.S512750. eCollection 2025.
Sub-Tenon's and topical anesthesia are the most common anesthetic techniques employed for cataract surgery. The objectives were to compare the effectiveness of intraoperative analgesia between the two techniques.
A systematic review was performed of three databases (MEDLINE, EMBASE, CENTRAL) from inception until August 2023. Included were adult patients undergoing routine cataract surgery with sub-Tenon's or topical anesthesia. Excluded were studies using systemic medications and complicated surgeries. The primary outcome was intraoperative analgesia assessed by patient reported pain scores. Secondary outcomes were post-operative pain at 30 minutes and 24 hours, patient satisfaction, surgeon satisfaction and complications. Risk of bias was evaluated using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Outcomes were statistically assessed with meta-analyses where able.
Twelve studies with 1370 patients were included in the meta-analysis. Sub-Tenon's block provided better intraoperative analgesia with lower pain scores (SMD -0.53, 95% CI -0.70 to -0.36; p < 0.001) which remained significant on subgroup analysis of six studies with uniform pain scales (MD -0.84, 95% CI -1.22 to -0.47; p < 0.001). Instances of severe intraoperative discomfort requiring rescue regional anesthesia were reported with topical anesthesia. While there was no difference in pain scores at 30 minutes or 24 hours post-operatively, higher patient and surgeon satisfaction was found with sub-Tenon's anesthesia. Serious complications were rare, with a higher reported rate of posterior capsule rupture with topical anesthesia. Only two of fourteen studies were considered an overall low risk-of-bias.
Sub-Tenon's block provides marginally better intraoperative analgesia during cataract surgery over topical anesthesia. Both can be considered effective for uncomplicated cataract surgery.
球后麻醉和表面麻醉是白内障手术中最常用的麻醉技术。目的是比较这两种技术在术中镇痛方面的效果。
对三个数据库（MEDLINE、EMBASE、CENTRAL）从建库至2023年8月进行了系统评价。纳入的是接受球后或表面麻醉的常规白内障手术的成年患者。排除使用全身药物和复杂手术的研究。主要结局是通过患者报告的疼痛评分评估的术中镇痛情况。次要结局是术后30分钟和24小时的疼痛、患者满意度、外科医生满意度和并发症。使用修订的Cochrane随机试验偏倚风险工具（RoB 2）评估偏倚风险。在可行的情况下，采用荟萃分析对结局进行统计学评估。
荟萃分析纳入了12项研究，共1370例患者。球后阻滞提供了更好的术中镇痛，疼痛评分更低（标准化均数差-0.53，95%可信区间-0.70至-0.36；p<0.001），在六项使用统一疼痛量表的研究的亚组分析中这一结果仍然显著（平均差-0.84，95%可信区间-1.22至-0.47；p<0.001）。表面麻醉报告了需要补救性区域麻醉的严重术中不适情况。虽然术后30分钟或24小时的疼痛评分没有差异，但球后麻醉的患者和外科医生满意度更高。严重并发症很少见，表面麻醉后囊膜破裂的报告发生率更高。14项研究中只有两项被认为总体偏倚风险较低。
在白内障手术中，球后阻滞在术中镇痛方面比表面麻醉略好。两者都可被认为对无并发症的白内障手术有效。
