A new technique of local anesthetic administration has been used for 50 patients undergoing cataract extraction. The simple technique involves direct transconjunctival infiltration of local anaesthetic directly to the sub-Tenon's space, in the inferior-nasal quadrant, using a blunt 19-gauge Southampton cannula. This method seeks to avoid the risks of retrobulbar haemorrhage, perforation of the globe, damage to the optic nerve, and injection into the subarachnoid space, whilst providing prolonged and reliable anaesthesia. Akinesia is achieved by the inferior-nasal placement of solution and if not sufficient, a top-up can easily be given. Patients graded any discomfort or pain using a 10 cm visual analogue graphical pain score chart with numerical and descriptive rating scale. The delivery of 50:50 mixture of lignocaine 2% and bupivacaine 0.5% anaesthetic was evaluated by patients with a median response of 'slight discomfort'. The operative procedure was graded with a median of 'no pain or discomfort', both for extracapsular cataract extraction and phakoemulsification. This is a new, modified, sub-Tenon technique which is simple, reliable, and which offers excellent anaesthesia and akinesia and avoids a sharp instrument being passed into the orbit.
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