Analgesic effect of supplemental intracameral lidocaine during phacoemulsification under topical anaesthesia: a randomised controlled trial

Tan, Colin S.; Fam, Han-Bor; Heng, Wee-Jin; Lee, Hung-Ming; Saw, Seang‐Mei; Eong, Kah‐Guan Au

doi:10.1136/bjo.2010.188003

Cited by 41 publications

(41 citation statements)

References 35 publications

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“…Similarly, Apil et al 6 reported that intraoperative pain was not associated with age or gender in their study. However, in a study including 506 patients, Tan et al 18 found that female patients experienced more pain during cataract surgery, while Gombos et al 19 reported that young patients were more sensitive to pain during cataract surgery.…”

Section: Discussionmentioning

confidence: 99%

Pain Perception in Phacoemulsification with Topical Anesthesia and Evaluation of Factors Related with Pain

Dadacı¹,

Borazan²,

Acır³

2016

tjo

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Objectives:Evaluation of pain during and after phacoemulsification with topical anesthesia in patients with senile cataract and investigation of factors related with pain.Materials and Methods:Ninety-two adult patients scheduled for routine clear corneal phacoemulsification with topical anesthesia who had no previous cataract surgery in their fellow eyes were included in the study. Verbal pain scale and visual analog scale were used to measure pain intensity. Demographic characteristics, concomitant systemic diseases, drug consumption, need of additional anesthesia during surgery, surgical complications, duration of surgery and surgeon comfort were also evaluated for each patient.Results:Seventy-two patients (78.3%) reported pain during surgery and 68 patients (73.9%) reported pain in the period after the surgery. When the intensity of pain during the surgery was evaluated, the percentage of patients reporting mild, moderate and intense pain was 35.9%, 25.0% and 17.4%, respectively. The average verbal pain score during the surgery was 1.4±1.0 (0-3). Reported pain level was not associated with age or gender (p>0.05). Diabetic patients and patients who consumed nonsteroidal anti-inflammatory drugs in the morning before operation reported less pain during and after the surgery (p<0.05). There were no complications except posterior capsule rupture in one patient. Duration of surgery was longer in patients who reported pain during surgery (p<0.05). There was no significant difference between pain reported during surgery and surgeon comfort (p>0.05).Conclusion:Patients frequently experience pain during phacoemulsification with topical anesthesia. Although pain perception does not affect surgical success, preoperative administration of analgesics in suitable patients or giving additional anesthesia to patients reporting severe pain during surgery may increase patient comfort.

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Section: Discussionmentioning

confidence: 99%

Pain Perception in Phacoemulsification with Topical Anesthesia and Evaluation of Factors Related with Pain

Dadacı¹,

Borazan²,

Acır³

2016

tjo

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“…Studies showed that the use of supplementary intracameral lidocaine injection with topical anesthesia is an effective and safe adjunct for decreasing intraoperative pain [18, 19], whereas another study reported there was no significant difference when using additional intracameral anesthesia [20]. This procedure might be necessary according to the needs of the surgeon or patient.…”

Section: Discussionmentioning

confidence: 99%

Clinical Analysis of Ocular Parameters Contributing to Intraoperative Pain during Standard Phacoemulsification

Kang

Kim

et al. 2017

Journal of Ophthalmology

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Purpose. To study the correlation between ocular parameters and subjective pain that patients perceived during phacoemulsification. Methods. Medical records of 142 patients who underwent standard phacoemulsification under topical anesthesia between March and August 2016 were retrospectively reviewed. The pain during phacoemulsification and 1 h after surgery was assessed and compared using a visual analog scale. In addition, demographic data, preoperative biometric parameters, and intraoperative surgical parameters were recorded. Results. Mean age of patients was 67.49 ± 12.50 years. The mean pain score was 2.26 ± 0.85 during phacoemulsification and 0.40 ± 0.69 postoperatively. Intraoperative pain was significantly associated with higher preoperative intraocular pressure (β = 0.220, P = 0.016), greater anterior chamber depth (β = 0.210, P = 0.028), and greater axial length (β = 0.181, P = 0.043). Conclusions. To reduce the subjective pain when patients have high preoperative intraocular pressure, large anterior chamber depth, or great axial length, supplementary procedures may be required.

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“…The use of lidocaine gel as a topical anes thetic in phacoemulsification is thought to hydrate the cornea thus improving visualization by the surgeon during surgery and to reduce the need for the postoperative administration of a balanced salt solution (BSS) (19) . Intracameral addition of lidocaine is performed quite often (20)(21)(22)(23)(24) ; because in topical approaches only the trigeminal nerve ends in the cornea and conjunctiva are anesthetized, whereby complementary anesthesia by means of intracameral unpreserved lidocaine is nee- ded to avoid the irritation of the ciliary nerves due to occasional manipulation of the iris. Current evidence shows that intracameral lidocaine as a supplement in topical anesthesia induces significant reduction in pain perception during surgery when compared with topical anesthesia alone.…”

Section: Discussionmentioning

confidence: 99%

Assessing patient satisfaction with cataract surgery under topical anesthesia supplemented by intracameral lidocaine combined with sedation

Fernandes¹,

Souza²,

Vasconcelos

et al. 2013

Arq. Bras. Oftalmol.

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INTRODUCTIONSignificant changes have been introduced to the techniques and instruments used for cataract surgery over the past 20 years. Such changes include phacoemulsification without corneal suture and the development of foldable intraocular lenses, which allow smaller and self-sealing incisions (1) . Additionally, a wide range of anesthetic techniques has been developed for cataract surgery during that period, including general, ophthalmic regional, and topical anesthesia (2) . ABSTRACTPurpose: Ocular akinesia, the use of anticoagulants, and patient collaboration are some of the factors that must be taken into consideration when choosing the appropriate anesthesia for phacoemulsification cataract surgery. The satisfaction of patients with the use of topical anesthesia and conscious sedation for this procedure has not been enough described in Brazil. Conscious sedation allows patient walk and answer a voice command. To assess the satisfaction, pain, and perioperative hemodynamic alterations of patients subjected to phacoemulsification under conscious sedation and topical anesthesia supplemented with intracameral lidocaine. Methods: Prospective cohort non-controlled study that included patients treated by the same surgical team over a 70-day period. Sedation was performed with midazolam at a total dose of 3 mg and topical anesthesia with 0.5% proxymetacaine chlorhydrate and 2% lidocaine gel combined with 2% lidocaine by intracameral route. The intraoperative vital parameters, scores based on the Iowa Satisfaction with Anesthesia Scale (ISAS), and the pain visual analog scale (VAS) were recorded at several time points after surgery. Results: A total of 106 patients were enroled in study (73.6% female), the mean age was 65.9 years. The surgical procedures lasted 11.2 minutes on average. The hemodynamic parameters did not exhibit significant changes at any of the investigated time points. The average ISAS score was 2.67 immediately after surgery and 2.99 eight hours after the surgery; this increase was statistically significant (p<0.0001). More than two-thirds (68.9%) of the participants (73 patients) did not report any pain in the transoperative period, and 98.1% of patients denied the occurrence of pain after surgery. Conclusions:Patients that received topical anesthesia supplemented by intracameral lidocaine combined with sedation for phacoemulsification cataract surgery reported adequate level of satisfaction with the anesthetic choice. Furthermore, the patients exhibited hemodynamic parameter stability and pain control.

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Analgesic effect of supplemental intracameral lidocaine during phacoemulsification under topical anaesthesia: a randomised controlled trial

Abstract: The use of 0.5 cc of 1% intracameral lidocaine during phacoemulsification under topical anaesthesia significantly reduces pain experienced by patients. Risk factors for pain include females, non-Chinese and previous cataract surgery.

Cited by 41 publications

References 35 publications

Pain Perception in Phacoemulsification with Topical Anesthesia and Evaluation of Factors Related with Pain

Pain Perception in Phacoemulsification with Topical Anesthesia and Evaluation of Factors Related with Pain

Clinical Analysis of Ocular Parameters Contributing to Intraoperative Pain during Standard Phacoemulsification

Assessing patient satisfaction with cataract surgery under topical anesthesia supplemented by intracameral lidocaine combined with sedation

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