Purpose: To evaluate the efficacy of TOPICAL ANESTHESIA for clear corneal phacoemulsification in Iranian patients at Farabi Hospital. Setting: Department of Ophthalmology, University of Tehran, Tehran, Iran. Methods: An interventional case series was performed on 58 consecutive patients that underwent clear cornea phacoemulsification under TOPICAL ANESTHESIA. Information about intra-operative & postoperative pain (score 1=without pain to score 3= severe pain), visual outcome, cooperation between patient and the surgeon, patient satisfaction from surgery, mean surgical time, intraoperative and postoperative complications were reordered in specific code sheets and were analyzed by SPSS 10 computer software. TOPICAL ANESTHESIA was achieved with tetracaine drop 0.5% and injection of preservative free lidocaine 1% in the AC, without any additional ANESTHESIA or sedation. Surgery was performed through a 3.2mm temporal corneal tunnel with in the bag (intercapsular) phacoemulsification. Results: From 58 patients (29 female, 29 male) with mean age of 58.5 yr and mean preoperative UCVA=1/10 (1/100-3/10), 86% had BCVA≥5.10 one month after surgery and 43% had BCVA≥10/10 and mean BCVA was 8/10 and mean improvement in visual acuity was 6.7 snellen lines. Mean surgical time was 28/8' (18'-50'), complications were: 2 cases of vitreous loss, 1 case of iris touch to phaco probe, 1 case of severe postsurgical uveitis and 1 case of severe corneal edema: Overall mean pain score was 1.4, 62,1% of patients have Grade 1, 32/8% Grade 2, 5/1% Grade 3 pain. 75.9% of the patients had good to excellent cooperation with surgeon, 19% medium and 5.2% poor cooperation. 74.1% of patient was very satisfied from this surgical method. Conclusion: TOPICAL ANESTHESIA was an effective and easy procedure for phacoemulsification, providing good perioperative pain tolerance by patients and is simple with minimal complications for phaco surgeons.  

Background: Multiple clinical trials targeted the assessment of cognitive function following local versus general ANESTHESIA in patients undergoing ophthalmic surgery, but no previous clinical trials have focused on the effect of TOPICAL ANESTHESIA on cognitive function. Objectives: This study aimed to compare the effect of local ANESTHESIA with lidocaine 2% versus TOPICAL ANESTHESIA with Oxybuprocaine (benoxinate hydrochloride 0. 4%) on cognitive function in patients undergoing elective cataract surgery. Methods: This is a prospective randomized clinical trial carried out on 60 patients undergoing elective cataract surgery by phacoemulsification. Thirty patients received local ANESTHESIA with lidocaine 2% and thirty patients received TOPICAL ANESTHESIA with Oxybuprocaine (benoxinate hydrochloride 0. 4%). Patients’ satisfaction was assessed postoperatively using the Iowa satisfaction with ANESTHESIA scale (ISAS). Cognitive assessment for all patients was done preoperatively and 1 week postoperatively using paired-associate learning test (PALT) and category verbal fluency (VF) test (animal category). Results: There was no statistically significant difference between local and TOPICAL ANESTHESIA groups in the mean of responses to the 11 statements of ISAS (P = 0. 071). Regarding cognitive assessment, there was a statistically significant postoperative decline in the local ANESTHESIA group in both PALT scores (P = 0. 005) and VF scores (P = 0. 01). In the TOPICAL ANESTHESIA group, there was no statistically significant difference between pre-and postoperative PALT scores (P = 0. 326) or VF scores (P = 0. 199). Conclusions: Postoperative cognitive dysfunction following elective cataract surgeries under local ANESTHESIA can be attributed to the effect of local ANESTHESIA rather than the effect of surgery.

Recently, smal incision cataract extraction by phaco and implantation of a foldable Intraocular lense with TOPICAL ANESTHESIA has been used in an attempt to decrease the complication of general ANESTHESIA and peribulbar injection. To compare effects and complications of TOPICAL, local and general ANESTHESIA. 92 patients admitted to Immam Hosein hospital for cataract surgery, were randomly assigned to three groups and surgery was done under different methods of ANESTHESIA. during routine ECCE, lid and globe movements, miosis and viterous bulg were observed more in TOPICAL ANESTHESIA than the other techniques, but serious complications Such as posterior capsular rupture and viterous loss were not seen. Because of less systemic and local complications and rapid return of vision and possibility of outpatient surgery, TOPICAL ANESTHESIA shoud be considered as an alternative to local and general methods.

TOPICAL ANESTHESIA (TA) may accompany more discomfort for some patients during cataract surgery. We aimed to evaluate the potential factors that can be used for predicting patient’ s cooperation during phacoemulsification surgery under TA. One hundred sixty consecutive cases that were candidate for phacoemulsification surgery were enrolled in this prospective study. Patients’ sex, age, place of residence (urban or rural), education level (literate and illiterate) and physical examination variables (visual acuity, reaction to eye drop, cooperation during tonometry, and reaction to press on the lacrimal sac before surgery) evaluated. Patients’ cooperation during surgery was classified as successful (good and satisfactory) or failed (weak) groups. In this study, 103(64. 4%) cases showed good or satisfactory cooperation, and others had weak cooperation. There was no correlation between patients’ cooperation during surgery and sex (P=0. 2), age (P=0. 7), place of residency (P=0. 3), and education level (P=0. 3). The successful group showed a higher rate of non-reaction to eye drop (P=0. 0001), good cooperation during tonometry (P=0. 0001), non-reaction to press on lacrimal sac (P=0. 0001), and lower visual acuity (P=0. 045). In the multi-logistic regression, non-reaction to eye drop (OR=66. 4), good cooperation during tonometry (OR=21. 2, good vs. bad and OR=7. 2, satisfactory vs. bad), lower visual acuity (OR=7, <0. 1 vs. 0. 1-0. 4 d) are the significant predictors for the success of TA. This study showed that some ocular examination tests before surgery (visual acuity, reaction to eye drop, cooperation during tonometry, and reaction to press on the lacrimal sac) could predict patients’ cooperation during phacoemulsification surgery under TA.

Background: Epidural ANESTHESIA is one of the most common ANESTHESIA methods, in surgical procedures.Since there is not any exact information about the spread of local anesthetic substances in epidural area, in this study we evaluated the distribution of Bupivacaine in epidural ANESTHESIA.Methods: After giving necessary information and signing the permission form, 24 patient candidates for elective cholecystectomy were enrolled in the study. They were selected by simple probable method.Before the surgery in sitting position by aseptic technique 8 CC bupivacaine plus 1 CC magnevist (as contrast) injected to the epidural space. Then patient transferred to the MRI room and images prepared by MRI studied by the radiologist. Heart rate, systolic and diastolic blood pressure and mean arterial pressure were measured at the injection time and 5 and 10 minute later.Findings: Among 24 patients (15 women and 9 men) we recognized that the mean distribution of applied medications in men and women were 4.8 and 5.5 level respectivly (P<0.05). There was not any relationship between local anesthetic distribution with age and weight. Height and body mass index had a significant convert correlation with the distribution of bupivacaine. Heart rate, systolic and diastolic blood pressure and mean arterial pressure were significantly decreased in studied times.Conclusion: We found that the distribution of bupivacaine among men are less than women. The distribution of bupivacaine in cephalad direction was more than codal direction.

Background - Aim: Recently small incision cataract extraction with phacoemulsitication and implantation of foldable I.O.L , using new technique of TOPICAL ANESTHESIA has evaluated to decrease cardio respiratory arrests . retrobulbar hemorrhages and globe perforation due to general ANESTHESIA or periocular injections.Materials & Methods: In this study 3 methods of ANESTHESIA (general, local, TOPICAL) were investigated on 92 cataractous eyes of patients, at Emam Hossein Medical center in 1994-1995.Results: During routine E.C.C.E, lid and globe movements, globe sensation, miosis and vitrous buldge, were more observedin TOPICAL ANESTHESIA than other techniques, but serious complications such as posterior capsule rupture and vitrous loss were not seen.Conclusion: For the sake of less systemic and local complications of TOPICAL ANESTHESIA and rapid return of vision and possibility of out patient surgery in cooperative patients without any risks, this method should be considered as an alternative technique to local and general ANESTHESIA.

Introduction: Injections in dentistry are accompanied by pain, discomfort, and anxiety. Many interventions have been undertaken so far to reduce this discomfort. This study aimed to assess the effect of vibration, cold, and TOPICAL ANESTHESIA on the reduction of pain experienced during infiltration injections in the anterior maxilla.Materials and Methods: This study is a randomized clinical trial conducted in the summer of 2023 in the Endodontic department of the Faculty of Dentistry, Isfahan University of Medical Sciences, on 200 patients who needed root canal treatment of an upper maxillary tooth. Before the injection in the buccal vestibule area, in the first group cold, in the second group vibration, in the third group TOPICAL, anesthetic gel was placed, and in the fourth group (control) only the injection was done without intervention. The pain level experienced when the needle enters and during the injection of the anesthetic in the anterior region of the maxilla was recorded using the Visual Analog Scale (VAS). The data was analyzed using variance analysis and the Tukey tracking test (α = 0.05).Results: Concerning needle insertion pain, superficial ANESTHESIA gel and vibration have been equally effective in reducing pain in the front of the maxilla and are more effective compared to the cold and control groups (p value < 0.05). With pain during ANESTHESIA injection, surface anesthetic gel had the lowest average pain score, followed by vibration and cold, and the control group had the lowest average pain score, respectively (p value < 0.05). No significant relationship was found between the pain score of needle insertion and anesthetic injection in the front of the maxilla and the gender of the patients (p value < 0.05).Conclusion: The use of TOPICAL ANESTHESIA and vibration devices is effective in reducing the pain of needle insertion and during injection in the infiltration of the anterior maxilla.

Purpose: To compare the effectiveness of TOPICAL and sub‑Tenon’s ANESTHESIA in providing pain relief during phacoemulsification.Methods: This randomized controlled trial was carried out at a tertiary eye care hospital, Coimbatore, Tamil Nadu, India. Patients who underwent phacoemulsification through self-sealing clear corneal incision with foldable intra‑ocular lens implantation were randomized into two groups. Group 1 (n=100) received TOPICAL ANESTHESIA with 0.5% proparacaine (Paracaine, Sunways India Pvt. Ltd., India) drops. Group 2 (n=100) received sub‑Tenon’s infiltration with 2% lignocaine (Xylocaine, AstraZeneca Pharma India Pvt. Ltd., India). As per study criteria, patients graded the pain during administration of ANESTHESIA, during surgery and after surgery on a visual analogue pain scale. The surgeon graded overall patient co‑operation. The complications were also noted. Data analysis was performed using Statistical Package for Social Sciences version 11. Student’s t‑test and Chi‑square test were used for comparison of variables between the groups.Results: Sub-Tenon’s ANESTHESIA provided statistically significant better intra‑perative pain relief and patient satisfaction than TOPICAL ANESTHESIAt. No statistically significant difference was noted between the two groups regarding pain during administration, postoperative pain, and surgeon satisfaction.Conclusion: Sub-Tenon’s ANESTHESIA provides better pain relief than TOPICAL ANESTHESIA during phacoemulsification.

Background: Ketamine is the only anesthetic agent that leads to an increase of blood pressure and heart rate by activation of sympathetic nervous system. However, there is a controversy about this effect of ketamine especially if used in small dosage. We proposed to evaluate the hemodynamic effect of small dose of ketamine during Phacoemulsification.Methods: One hundred patients of ASA physical status I-III were chosen for this prospective, randomized, double-blind placebo-control study. Our patients were assigned randomly to two groups, ketamine group (n=50) and a control group (n=50). After premedication, 0.15 mg/kg ketamine was injected intravenously in ketamine group. After three minutes Phacoemulsification was begun under TOPICAL ANESTHESIA. The hemodynamic variables were recorded during the procedure and compared between two groups.Results: The systolic, diastolic and mean blood pressure were statistically significantly higher in the ketamine group (p<0.001) during the procedure. The heart rate during operation was higher in the ketamine group compared to control group (p<0.001). 46 (92%) patients in the ketamine group and 38 (76%) patients in the control group were satisfied according to surgeons (p=0.001). Nausea and vomiting occurred at similar rates in each group. Also, hallucination and other psychological events did not occur in either of the groups.Conclusion: We found that systolic, diastolic, mean arterial blood pressure in patients who received small dose of ketamine were higher during the operation.