Abstract:
Background: Worldwide, cataract surgery is one of the most commonly performed operations and the incidence is primarily associated with increasing age. Commensurate with an ageing population, cataract surgery is destined to become even more frequently performed. Anaesthesia for cataract surgery to render the procedure as comfortable for the patient as possible is commonly undertaken using a sub-Tenon’s regional anaesthetic. Although generally well tolerated, many patients find the anaesthetic procedure uncomfortable and at times painful, and therefore a distressing process. Objective: To investigate the factors associated with pain and sub-Tenon’s anaesthesia with the purpose of making the process of local anaesthesia prior to cataract surgery as comfortable and as close to pain-free as possible. Participants: Of the 1183 adults (18+) undergoing cataract surgery with sub- Tenon’s anaesthesia at Auckland District Health Board Ophthalmic Theatres between 1st October 2009 to 1st April 2010, a total of 617 (mean age: 72.4), response rate, 57.1 percent participated in the survey. Methods: Participants completed the Verbal Numeric Pain Scale (VNPS) of their pain levels, which were interviewer administered pre anaesthetic, post sub-Tenon’s injection and post cataract surgery. Baseline demographics including age, gender and ethnicity were collected as well as five additional factors (type of anaesthetic, time of day, anaesthetic practitioner, volume of anaesthetic and rate of injection). Factors were investigated using Generalised Estimated Equations. Results: Females reported higher levels of pain post sub-Tenon’s injection and post cataract surgery than males (P=0.0008). There were no other statistical differences identified. Conclusion: The study has particular relevance to nursing practice as no statistical differences were noted between the medical anaesthetic practitioners (Consultant and Registrar) and nurse specialist in relation to reported pain in the administration of the sub-Tenon’s injection. Within the current scope of practice, this may have ramifications on future workforce planning associated with the makeup of anaesthetic practitioner for routine cataract surgery. In addition, greater attention is required regarding the perceived pain of women and mechanisms to alleviate this maybe required.