A head-to-head comparison of adverse events: Peribulbar versus sub-Tenon’s anesthesia in small incision cataract surgery

BACKGROUND: Cataract extraction is among the most commonly performed surgical procedures and is widely recognized for its high safety profile. With advances in surgical methods, small incision cataract surgery (SICS) now allows the use of shorter-acting and minimally invasive anesthetic techniques. The present study aimed to evaluate and compare the efficacy of peribulbar and sub-Tenon's anesthesia with respect to analgesic effectiveness, ocular akinesia, and anesthesia-related complications such as subconjunctival hemorrhage, chemosis, retrobulbar hemorrhage, globe perforation, and brainstem anesthetic spread. PURPOSE: To assess and compare peribulbar and sub-Tenon's anesthetic techniques in SICS concerning pain control, ocular movement restriction, and complication rates including subconjunctival hemorrhage, chemosis, retrobulbar hemorrhage, globe perforation, and brainstem injection. METHODS: This hospital-based observational study was conducted in the Department of Ophthalmology on 122 eyes undergoing SICS. Participants were randomly assigned into two equal groups of 61 each, receiving either peribulbar or sub-Tenon's anesthesia. Data were analyzed using SPSS version 26.0, and graphical representations were prepared with Microsoft Excel 2021. Statistical tests were applied, and a P value of less than 0.05 was considered statistically significant. RESULTS: The findings showed that administration-related pain was greater in the peribulbar group, which also achieved more complete akinesia. However, sub-Tenon's anesthesia demonstrated a faster onset, fewer adverse events, and overall better safety. CONCLUSION: Sub-Tenon's anesthesia represents a reliable and safer alternative to peribulbar anesthesia for SICS, offering sufficient analgesia with fewer and milder complications.