Abstract

Background:
Phacoemulsification cataract surgery is one of the most commonly performed ophthalmic procedures, aiming to restore vision in patients with cataracts. Despite its minimally invasive nature, postoperative pain and discomfort can have a considerable effect on patient recovery and satisfaction. Ropivacaine, a long-acting amide local anesthetic, has been explored as an anesthetic option for cataract surgery because of its long-lasting analgesic effects and good safety profile. This systematic review and meta-analysis aimed to evaluate the safety and efficacy of Ropivacaine in phacoemulsification cataract surgery, focusing on postoperative pain reduction, surgeon satisfaction, and operative efficiency.
Methods:
Following PRISMA guidelines, a thorough search for randomized controlled trials (RCTs) comparing ropivacaine with control interventions in phacoemulsification cataract surgery was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library. Eight RCTs involving 2,891 patients met the inclusion criteria. Data extraction and risk-of-bias assessment were performed using the ROB2 tool. Statistical analysis was conducted using RevMan 5.3, with heterogeneity assessed using I² and the chi-square test.
Results:
Ropivacaine significantly reduced postoperative pain (VAS scores) (MD = -0.49, 95% CI: -0.86 to -0.12, p = 0.010, I² = 94%) and improved surgeon satisfaction levels (MD = 0.32, 95% CI: 0.09 to 0.55, p = 0.006, I² = 59%). However, duration of surgery (MD = -0.33 minutes, p = 0.66), duration of analgesia (MD = -72.04 min, p = 0.27), onset time of anesthesia (MD = 0.22 minutes, p = 0.69), and poor surgical satisfaction incidence (OR = 0.44, p = 0.29) showed no statistically significant differences.
Conclusion:
Ropivacaine showed notable advantages in lowering postoperative pain and raising surgeon satisfaction. However, its effect on other surgical parameters remains unclear. Additional large-scale RCTs are required to confirm these findings and optimize anesthetic techniques for cataract surgery.

Key words: Ropivacaine, phacoemulsification, cataract surgery, anesthesia, postoperative pain, meta-analysis, randomized controlled trials