Deep topical anesthesia with ropivacaine-soaked sponge for phacoemulsification

Abstract

Purpose To assess safety and efficacy of deep topical anesthesia with ropivacaine-soaked sponge compared with topical anesthesia with oxybuprocaine in patients undergoing phacoemulsification. Methods This was a retrospective study where records of patients operated for cataract were evaluated. Patients using a visual analogue scale scored pain during surgery, and the surgeon on a questionnaire recorded ease of operation. Medical records were evaluated for patients who received topical anesthesia with multiple administrations of oxybuprocaine 0.4% or those who received deep topical anesthesia with a polyvinyl acetal sponge impregnated with ropivacaine 0.75% and positioned under the eyelid 30 min before surgery.Results A total of one hundred patient records, equally divided in patients receiving deep topical anesthesia or topical anesthesia, were included. The visual analogue scale scores among the groups were statistically significant for a lower pain score in patients who received deep topical anesthesia with ropivacaine-soaked sponges (p = 0.0069). The average surgeon score was significantly higher for the deep topical anesthesia group indicating favorable ease of surgery (p = 0.0341). Six patients had major complications during surgery. No additional anesthesia was necessary to manage the complications in four patients in the deep anesthesia group, whereas propofol was used for the induction and maintenance of anesthesia in two patients in the topical anesthesia group. Conclusions Deep topical anesthesia with ropivacaine-soaked sponges performed as well as topical oxybuprocaine regarding safety and efficacy. It provided a lower patient pain score, favorable surgeon satisfaction, and long-lasting anesthesia.

A double-blinded randomized clinical trial for pain perception: The efficacy and safety of topical cold saline solution anesthesia in phacoemulsification

“…[ 27 ] Cryoanalgesia can also affect separate sensory nociceptor TRP ion channels that exist for the transmission to the central nervous system of the modality and the spatial-temporal characteristics of peripheral non-noxious and noxious stimuli. [ 28 ] The cold application can also provide local anesthesia and decrease ocular discomfort (burning and stinging) via vasoconstriction promotion, which decreases the release of inflammatory mediators (leukotrienes and prostaglandins) similar to the mechanism of NSAIDs. [ 1 25 29 ]…”