Efficacy and safety of Adrenaline-augmented subconjunctival anesthesia in phacoemulsification: A randomized controlled trial

Background/Objectives: Cataract surgery, particularly phacoemulsification, has evolved significantly, benefiting millions worldwide. The choice of anesthesia technique impacts patient comfort and procedural efficacy. Subconjunctival anesthesia has emerged as an attractive alternative due to its potential to provide effective pain relief and surgeon comfort during surgery. A different aspect of this study is the inclusion of 1:100,000 adrenaline in 2% lignocaine for subconjunctival anesthesia, which has not been previously studied. Subjects/Methods: A prospective, randomised, comparative study involving 196 eyes evaluated the safety and efficacy of subconjunctival anesthesia in phacoemulsification surgery. Pain scores during surgery and one hour post-surgery, surgeon discomfort, postoperative corneal clarity, complications, and additional anesthesia requirement were assessed. Statistical analysis employed descriptive statistics, t-tests, chi-squared tests, and correlations. Results: Subconjunctival anesthesia significantly lowered pain scores during surgery (p < 0.001) and one hour post-surgery (p < 0.001) compared to topical anesthesia. Surgeon discomfort was notably reduced with subconjunctival anesthesia (p < 0.001). Subconjunctival hemorrhage (p = 0.012) and redness (p = 0.024) were more prevalent postoperatively. No significant difference was observed in intraoperative complications (p = 0.573) or postoperative corneal clarity (p = 0.347). Conclusion: Subconjunctival anesthesia, with the inclusion of 1:100,000 adrenaline in 2% lignocaine, provides effective pain relief and reduces surgeon discomfort during phacoemulsification surgery. The addition of adrenaline extends anesthesia duration. While immediate postoperative effects exist, subconjunctival anesthesia holds promise for enhanced patient comfort and procedural efficiency. Further research is needed to validate its long-term benefits and broader implications in evolving ophthalmic surgical practices.