Scolaris Content Display Scolaris Content Display

Cochrane Database of Systematic Reviews

백내장수술시 테논낭밑마취(sub‐Tenon‘s anesthesia)와 점안마취(topical anesthesia) 비교

Información

DOI:
https://doi.org/10.1002/14651858.CD006291.pub3Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 27 agosto 2015see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Anestesia

Copyright:
  1. Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Cifras del artículo

Altmetric:

Citado por:

Citado 0 veces por enlace Crossref Cited-by

Contraer

Autores

  • Joanne Guay

    Correspondencia a: Department of Anesthesiology, Faculty of Medicine, University of Sherbrooke, Sherbrooke, Canada

    [email protected]

    [email protected]

  • Karl Sales

    Department of Surgery/Ophthalmology, CSSS Rouyn‐Noranda, Rouyn‐Noranda, Canada

Contributions of authors

Updated review:

Joanne Guay (JG), Karl Sales (KS).

Co‐ordinating the review: JG.

Undertaking manual searches: JG.

Screening search results: JG, KS.

Organizing retrieval of papers: JG.

Screening retrieved papers against inclusion criteria: JG, KS.

Appraising quality of papers: JG, KS.

Abstracting data from papers: JG, KS.

Managing data for the review: JG.

Entering data into Review Manager: JG.

Analysing RevMan statistical data: JG.

Performing other statistical analyses not using RevMan: JG.

Interpreting data: JG, KS.

Making statistical inferences: JG.

Writing the review: JG, KS.

Securing funding for the review: departmental resources only.

Serving as guarantor for the review (one review author): JG.

Taking responsibility for reading and checking the review before submission: JG, KS.

Designing the literature search: Karen Hovhannisyan (KH).

Sources of support

Internal sources

  • University of Sherbrooke, Canada.

    Access to medical journals

  • University of Quebec in Abitibi‐Temiscamingue, Canada.

    Access to medical journals

External sources

  • Cochrane Anaesthesia Review Group, Denmark.

    Search strategy and list of abstracts

Declarations of interest

Joanne Guay: I have had no direct relationship with any pharmaceutical company or equipment manufacturer in the past five years. I have not acted as a witness expert in the past five years. I am not an author of any of the included or excluded studies. I do not hold stock other than mutual funds. During the past five years, I have received fees as speaker for two lectures given at the University of Dalhousie: one on regional anaesthesia for carotid endarterectomy, and the other on local anaesthetic‐related methaemoglobinaemia. My fees were paid by the University of Dalhousie. I am the editor of a multi‐author textbook on anaesthesia (including notions on general and regional anaesthesia). I receive fees for a course on airway management from University of Quebec in Abitibi‐Temiscamingue.

Karl Sales: I have had no direct relationship with any pharmaceutical company or equipment manufacturer in the past five years. I have not acted as a witness expert in the past five years. I am not an author of any of the included or excluded studies.

Acknowledgements

The first version of this review was prepared by Marc Davison, Sara Padroni, Catey Bunce and Heinrich Rüschen (Davison 2007). We would like to thank Karen Hovhannisyan for preparing the search strategy for the original review and the updated review, and for providing abstracts for this update. Relevant references for this update were provided by University of Sherbrooke and University of Quebec in Abitibi‐Temiscamingue.

We would also like to thank Cochrane Anaesthesia, Critical and Emergency Care editors ‐ Nathan Pace, Andrew Smith and Janet Wale ‐ for providing help with this updated review.

Version history

Published

Title

Stage

Authors

Version

2015 Aug 27

Sub‐Tenon's anaesthesia versus topical anaesthesia for cataract surgery

Review

Joanne Guay, Karl Sales

https://doi.org/10.1002/14651858.CD006291.pub3

2007 Jul 18

Sub‐Tenon's anaesthesia versus topical anaesthesia for cataract surgery

Review

Marc Davison, Sara Padroni, Catey Bunce, Heinrich Rüschen

https://doi.org/10.1002/14651858.CD006291.pub2

2006 Oct 18

Sub‐Tenon's anaesthesia versus topical anaesthesia for cataract surgery

Protocol

Marc Davison, Sara Padroni, Catey Bunce, Heinrich Rüschen

https://doi.org/10.1002/14651858.CD006291

Notes

Updated review February 2015

Despite using the same studies, we have had to change the conclusions from those of the original review (Davison 2007) on the basis of the following.

  1. We were able to pool the data of more studies (different techniques of data extraction). As a result of this, the new analysis shows that the higher level of pain with topic anaesthesia was overestimated by the inclusion of studies in which outcome assessors were not blinded to the anaesthetic technique used.

  2. The original review stated that surgeons had a small preference for the sub‐Tenon's technique. Possibly because they are now more familiar with topical anaesthesia, surgeons in various countries are telling us by their numbers that they are using almost exclusively topic anaesthesia, or at least in the majority of their patients. We can no longer say that they prefer sub‐Tenon's anaesthesia despite the results of RCTs performed years ago; this seems no longer true.

  3. The original review stated that topical anaesthesia was associated with a higher rate of intraoperative complications. We have calculated that the number of participants included in our review was insufficient to allow us to present conclusions on this.

Therefore, with the new analysis and integration of actual literature on the topic (up to 2014), we have had to change the conclusions, despite the fact that we did not add new studies to the analysis.

The original review (Davison 2007) was edited by Andrew Smith, Marialena Trivella, Anders Behndig and Maurizio Solca.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Aged; Aged, 80 and over; Female; Humans; Male;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Flow diagram of study selection for the updated review.
Figuras y tablas -
Figure 1

Flow diagram of study selection for the updated review.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Topical anaesthesia versus sub‐Tenon's anaesthesia, Outcome 1 Pain during surgery.
Figuras y tablas -
Analysis 1.1

Comparison 1 Topical anaesthesia versus sub‐Tenon's anaesthesia, Outcome 1 Pain during surgery.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Topical anaesthesia versus sub‐Tenon's anaesthesia, Outcome 2 Pain during anaesthesia administration.
Figuras y tablas -
Analysis 1.2

Comparison 1 Topical anaesthesia versus sub‐Tenon's anaesthesia, Outcome 2 Pain during anaesthesia administration.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Topical anaesthesia versus sub‐Tenon's anaesthesia, Outcome 3 Pain at 30 minutes after surgery.
Figuras y tablas -
Analysis 1.3

Comparison 1 Topical anaesthesia versus sub‐Tenon's anaesthesia, Outcome 3 Pain at 30 minutes after surgery.

Ir a la figura de la revisiónAbrir en una pestaña nueva
Summary of findings for the main comparison. Topical anaesthesia compared with sub‐Tenon's anaesthesia for cataract surgery

Topical anaesthesia compared with sub‐Tenon's anaesthesia for cataract surgery

Patient or population: patients with cataract surgery
Settings: surgery
Intervention: topical anaesthesia
Comparison: sub‐Tenon's anaesthesia

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Sub‐Tenon's anaesthesia

Topical anaesthesia

Intraoperative pain

Mean intraoperative pain in the intervention groups was
0.47 standard deviations higher
(0.29 to 0.66 higher)

501
(3 studiesa)

⊕⊕⊕⊕
High

Equivalent to 1.1 on a score from 0 to 10

Pain during administration of anaesthesia

Mean pain during administration of anaesthesia in the intervention groups was
0.20 standard deviations lower
(0.43 lower to 0.04 higher)

184
(2 studiesb)

⊕⊕⊝⊝
Lowc,d

Pain at 24 hours
Follow‐up: 1 day

Mean pain at 24 hours in the intervention groups was
0.47 standard deviations lower
(0.75 to 0.19 lower)

200
(1 study)

⊕⊕⊕⊝
Moderated

Equivalent to 0.2 on a score from 0 to 10

Surgeon's satisfaction
Scale from 0 to 10

Mean surgeon satisfaction in the intervention groups was
0.7 lower
(0.3 to 1.1 lower)

200
(1 study)

⊕⊕⊝⊝
Lowd,e

Participant satisfaction

Mean participant satisfaction in the intervention groups was
1.13 standard deviations lower
(0.3 to 1.96 lower)

26
(1 study)

⊕⊕⊕⊝
Moderated,f,g

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aWe retained only studies in which the outcome assessor was blinded to the anaesthetic technique.
bWe retained only parallel trials for this outcome.
cOne of the included studies was at high risk of bias for 3/7 items, at low risk for 2/7 items and at unclear risk for 2/7 items.
dWe downgraded the evidence on the basis of a small number of participants (arbitrarily fixed at ≤ 200) an/or a small number of available studies (≤ 2).
eOutcome assessor not blinded.
fWide confidence interval.
gSMD > 0.8.

Figuras y tablas -
Summary of findings for the main comparison. Topical anaesthesia compared with sub‐Tenon's anaesthesia for cataract surgery
Ir a la tabla de la revisión
Table 1. Complications

Study ID

Subconjunctival haemorrhage T vs ST

Chemosis T vs ST

Transient increase in intraocular pressure T vs ST

Posterior capsular tear T vs ST

Iris prolapsus T vs ST

Conversion to ST

Iritis T vs ST

Comments

Chittenden 1997

0

Complications not reported

Mathew 2003

0

Complications not reported

Rüschen 2005

1/14

Complications not reported

Sekundo 2004

0/50 vs 0/50

0/50 vs 0/50

5/50

1/50 vs 1/50

The topical anaesthesia group felt pain during cauterization of the episcleral vessels
and to a lesser extent throughout the second part of the operation

Srinivasan 2004

3/65 vs 2/136

0/65 vs 1/136

0

No participant required supplemental analgesia after surgery

Vielpeau 1999

25/25 vs 25/25a

0/25 vs 15/25

0/25 vs 0/25

0/25 vs 0/25

0

Zafirakis 2001

0/100 vs 22/100

0/100 vs 76/100

0

T: topical anaesthesia

ST: sub‐Tenon's anaesthesia

vs: versus

aAny amount

Figuras y tablas -
Table 1. Complications
Ir a la tabla de la revisión
Comparison 1. Topical anaesthesia versus sub‐Tenon's anaesthesia

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain during surgery Show forest plot

6

705

Std. Mean Difference (Random, 95% CI)

0.64 [0.43, 0.84]

1.1 Low risk for outcome assessor blindness

3

501

Std. Mean Difference (Random, 95% CI)

0.47 [0.29, 0.66]

1.2 Unclear risk for outcome assessor blindness

3

204

Std. Mean Difference (Random, 95% CI)

0.90 [0.61, 1.20]

2 Pain during anaesthesia administration Show forest plot

3

Std. Mean Difference (Random, 95% CI)

Subtotals only

2.1 Cross‐over trial

1

200

Std. Mean Difference (Random, 95% CI)

‐2.21 [‐2.57, ‐1.86]

2.2 Parallel trial

2

320

Std. Mean Difference (Random, 95% CI)

‐0.20 [‐0.43, 0.04]

3 Pain at 30 minutes after surgery Show forest plot

2

Std. Mean Difference (Fixed, 95% CI)

Subtotals only

3.1 Cross‐over trial

1

200

Std. Mean Difference (Fixed, 95% CI)

0.96 [0.67, 1.26]

3.2 Parallel trial

1

201

Std. Mean Difference (Fixed, 95% CI)

0.54 [0.24, 0.84]
Figuras y tablas -
Comparison 1. Topical anaesthesia versus sub‐Tenon's anaesthesia
Ir a la tabla de la revisión