Article Text
PDF
Abstract
Background and aims Sub-Tenon’s block (STB) is increasingly used for cataract surgery to reduce risk of complications related to needle blocks.1 The technique involves making a conjunctival incision with blunt forceps and scissors followed by insertion of a blunt cannula into the sub-Tenon’s space. Recently, a sub-Tenon’s technique has been described in which a small aperture in conjunctiva is made with a lacrimal dilator.2 This technique accelerates block performance, minimize local trauma, improves surgical field and avoids surgical incision of conjunctiva.3 We report preliminary results of a randomized, prospective, non-inferiority study comparing standard vs. lacrimal dilator-facilitated sub-Tenon’s block.
Methods Patients undergoing elective cataract surgery were enrolled into two groups; standard sub-Tenon’s dissected with Westcott scissors (WS) or entry portal obtained with a lacrimal dilator (LD) A 19G, 2.5 cm long sub-Tenon’s curved cannula was used in both groups to deliver 3 mL, 2% lidocaine. No sedation was used. Data collection included demography, procedure duration, chemosis, intraoperative analgesia (Numeric Rating Scale 1–10), akinesia (4-primary gazes) and the quadrant/s of subconjunctival haemorrhage on the first postoperative day.
Results Patients in both groups were comparable for demographic data, procedure duration, analgesia and akinesia (p>0.05). The incidence of chemosis and subconjunctival hemorrhage were significantly lower in Group LD (n=15) in comparison to Group WS (n=26) (p=0.001 and p<0.001, respectively).
Lacrimal dilator-facilitated entry during STB.
Subconjunctival haemorrhage following STB in the same patient; with lacrimal dilator in the right eye(a) and with scissors in the left eye(b).
Conclusions Incisionless sub-Tenon’s block with lacrimal dilator is a practical and effective alternative to standard technique with reduced chemosis and subconjunctival hemorrhage.