LETTERS TO THE EDITOR

Topical anesthesia associated with phacoemulsification. Experience with 312 patients

Mrs. Editor,

On the scientific article "Topical Anesthesia Associated with Sedation for Phacoemulsification. Experience with 312 Patients", the author reports conflicting results that I think compromise part of the discussion and the conclusions presented.

On methods, it was informed that after sedation with 1 mg of midazolam and instillation of anesthetic eye drops, patients also received 125 µg of alfentanil IV shortly before the surgery, and that the same amount would be repeated on bolus administration whenever necessary, in cases of pain or discomfort (euphemism for mild pain). Afterwards, it was reported that only 13.5% of the patients complained of pain during the surgery. However, by analyzing Table IV, it is noticeable that 303 patients (97.1%) received extra doses of alfentanil, i.e., they complained of pain during the surgery, and 275 of those patients (32%) needed 500 µg or more of this analgesic, up to a maximum of 1,250 µg.

Therefore, it is clear that topical anesthesia has a low efficacy and intravenous analgesic complementation with its known inconveniences is necessary. I do not want, nor can I, in this letter discuss the advantages and limitations of this type of anesthesia for phacoemulsification of the lens, but I think that the discussion and conclusions using this sample size should be based on results presented correctly; otherwise, they may overlook their importance.

Antônio Márcio S. Arantes Pereira, TSA