Regional anaesthesia techniques for cataract surgery in India: Practice patterns and compliance with guidelines – A survey study
V V Jaichandran, Ronnie George, Indu M. Sen, Renu Sinha, Tanvir Samra, Raja N. Rao, A RavichandarABSTRACT
Background and Aims:
Although cataract anaesthesia practice patterns have been surveyed in several countries, Indian data are lacking. This study aimed to determine preferred regional anaesthesia techniques for cataract surgery in India and evaluate adherence to existing guidelines.
Methods:
A structured 23-item cross-sectional online questionnaire covering current practices in pre-operative optimisation of the patient, regional anaesthesia techniques, and local anaesthetics/adjuvants administered was distributed electronically among cataract surgeons and ophthalmic anaesthesiologists in India.
Results:
Out of 597 responses, 49.7% were from private clinical practitioners, 32.7% from private institutions, and 17.6% from government hospitals. Peribulbar anaesthesia (34.2%) was the preferred choice, followed by topical anaesthesia (32.8%). Around 45% used injection adrenaline as an adjuvant, 20% used injection hyaluronidase >15 IU/mL, and 17% were unaware of the dosages administered. Pre-operative continuation of antiplatelets and anticoagulants was reported by 16.1% and 13.6% of respondents, respectively. A local anaesthetic combination of lignocaine + bupivacaine was preferred (56%), pre-operative fasting was advised for sedation by 31%, and pre-operative allergic skin test to hyaluronidase was performed by 22.8% respondents. Electrocardiogram and non-invasive blood pressure monitoring were used by 26% and 44% respondents, respectively.
Conclusion:
Peribulbar followed by topical anaesthesia are the most preferred anaesthesia techniques for cataract surgery in India. Practices such as continuation of oral antiplatelets before cataract surgery, limiting doses of hyaluronidase <15 IU/mL, and minimising the use of adrenaline should be incorporated in guidelines for the Indian population. Use of newer local anaesthetics (ropivacaine/levobupivacaine) needs to be encouraged, and pulse oximetry should be made mandatory for all.