Combined topical and intracameral anesthesia without sedatives is well tolerated by most phacoemulsification patients, according to results of a large, population-based series of small-incision phacoemulsification surgery. In addition, this anesthetic regimen was also effective in cases where complications or adverse events occurred.

Swedish researchers conducted a prospective observational study on all cases (N = 1,249) of cataract surgery during a 1-year period at Sunderby Hospital, Luleå, Sweden. Most patients administered dilating drops at home consisting of phenylephrine (2.5%) and cyclopentolate (1%) one drop, three times each, 15 minutes apart, starting 1 hour before leaving home. Upon arriving at the clinic, nurses administered additional mydriatic drops if necessary. Any patients who felt any anxiety were asked if they would prefer preoperative sedation, consisting of sublingual midazolam hydrochloride. Doses were determined by patient age and body weight; most patients received 2 mg to 3 mg.

Before eyes were rinsed with chlorhexidine solution (0.5 mg/mL), one drop of preservation-free amethocaine hydrochloride (1%) was given, followed a few minutes later by another drop. At the beginning of the procedure, a small dose (0.2 mL) of preservative-free lidocaine hydrochloride (1%; 10 mg/mL) is given intracamerally by the surgery. Patients who experienced pain during the procedure were given additional anesthesia: either topical amethocaine hydrochloride (1%) and/or additional intracameral lidocaine hydrochloride (1%).

A full 90% of patients had combined topical and intracameral anesthesia without sedation. Those who chose preoperative sedation were significantly younger (P = 0.0001) and more often female (P = 0.011).

A subgroup of patients (n = 12) was asked to complete short questionnaires to assess their satisfaction with the anesthetic regimen. In these patients, the median pain score after surgery was 0.7 (visual analog scale, 0-10). Pain scores of 1.9 or less were reported by 76% of patients. Those reporting a pain score of ≥ 2 received sedation and additional anesthetics more often.

No significant differences were seen in regards to age, sex, pulse rate, oxygen saturation, first or second eye surgery, or adverse intraoperative events in patients with pain scores of ≤ 1.9 and ≥ 2. In addition, no significant differences were seen in the percentage of complications or adverse events between patients who had sedation and those without sedation (6.4% vs. 7.2%, respectively; P = 0.94).