Tetracaine drops versus lidocaine gel for topical anaesthesia in cataract surgery

Background: in addition to intracameral anaesthesia, drop anaesthesia with tetracaine drops has been established for topical anaesthesia in cataract surgery. Anaesthesia with lidocaine gel is less established. We compared pain sensitivity of patients undergoing surgery with drop anaesthesia to patients who underwent surgery with gel anaesthesia. Patients and methods: In a questionnaire-based survey in which patients assessed their sensitivity to pain during cataract surgery, we compared the sensitivity to pain of 49 patients during surgery with gel anaesthesia to 62 patients who consecutively underwent surgery with drop anaesthesia. Patients assessed pain intensity postoperatively by checking off a 10-graduation pain scale. Lidocaine gel (2%) was applied once while tetracaine drops (1%) were applied three times.-All interventions were carried out by two surgeons as phakoemulsifications with implantation of a posterior chamber lens via posterior-limbal access. In addition to pain sensitivity we also considered the patients' age, duration of surgery and surgical complications. The data for the patients' age, the duration of surgery and the assessment of intensity were not normally distributed so that a Mann-Whitney-rank-sum test was performed. Results: No differences were observed between tho two groups, neither regarding age (P = 0.63) nor the duration of the surgical intervention (p = 0.43). However, in patients treated with tetracaine drops pain sensitivity was reported as being significantly less (mean 1,77) than in patients treated with lidocaine gel (mean 2.22; P < 0.043). 73.5% of patients with gel anaesthesia and 83.9% of those with drop anaesthesia reported "negligible" pains. There were no intra-operative complications. Conclusion: Both gel anaesthesia and drop anaesthesia are suitable methods for cataract surgery under local anaesthesia. According to patients' assessment, drop anaesthesia with tetracaine is better suited for pain elimination.