This single-centre Indian study assigned 122 eyes undergoing small incision cataract surgery to peribulbar or sub-Tenon's anaesthesia, 61 in each group, and compared pain, akinesia and complications including subconjunctival haemorrhage and chemosis.
The authors report that peribulbar injection was more painful to administer but gave more complete akinesia, while sub-Tenon's had a faster onset, fewer adverse events and a better overall safety profile. The abstract does not give the event rates, so the size of the difference cannot be judged from it.
For high-volume SICS services, sub-Tenon's is a reasonable choice where full akinesia is not essential, with the trade-off that some patients will retain eye movement. Choice should still reflect the surgeon's technique and the patient's cooperation.
- Consider sub-Tenon's anaesthesia for routine SICS where complete akinesia is not essential.
- Expect more residual eye movement with sub-Tenon's than with peribulbar block.
- Peribulbar block was reported as more painful to give and to have more minor complications.
- Keep peribulbar block for patients or surgeons who need a fully still globe.
Why it matters
Small incision cataract surgery is the workhorse operation of Indian eye care, and anaesthetic choice affects every list.
Don't overread it
A small single-centre study; the abstract gives no complication rates to judge effect size.
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