Aim: To compare the efficacy and safety of the medial canthus single injection peribulbar anaesthesia with the classic double injection (inferotemporal plus superonasal) technique for elective manual, sutureless, extracapsular cataract surgery at National Eye Centre Kaduna, Nigeria. Materials & Methods: A prospective, randomized, controlled, triple-masked, experimental study was carried out between October and December 2012. One hundred patients aged ≥50 years with uncomplicated senile cataracts were scheduled for manual sutureless extracapsular cataract extraction. They were randomly allocated to two equal groups for local anaesthetic injection using a mixture of xylocaine 2% + adrenaline 0.125mg/ml + hyaluronidase 15IU/ml by an anaesthetic nurse. One group received a single inferomedial percutaneous peribulbar injection; while the other received two percutaneous peribulbar injections at the inferotemporal and superonasal quadrants. The block was administered using 23G, 32mm needles on 5ml syringes for both groups. Time to achieve adequate akinesia for surgery; need for supplementary injections; pain of local anaesthesia and surgery were the primary outcome measures assessed. Secondary outcome measures included total number of injections; total volume of anaesthetic drug; complications of local anaesthesia; duration of surgery; as well as surgeon’s satisfaction with the block. i An objective 3-point scoring system was used to assess eyelid and ocular akinesia by a masked assessor. A subjective 4-point scoring system was used to grade the pain of anaesthesia and surgery by the patient; while the same was also used by the surgeon to grade his satisfaction with the anaesthetic block. Data was analysed using SPSS version 16 to generate summary statistics; while statistical tests employed were the unpaired t, X2 and Fisher’s Exact.