Intraoperative and postoperative pain in cataract surgery

Assam, Jed H.; Bernhisel, Ashlie; Lin, Amy

doi:10.1016/j.survophthal.2017.07.002

Cited by 21 publications

(23 citation statements)

References 96 publications

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“…The cornea has one of the densest concentrations of unmyelinated sensory nerve endings in the body [1,2], which are highly sensitive to mechanical stimulation, temperature, and various chemicals mediators, through receptors such as the transient receptor potential family [3]. Damage or irritation to these nerve endings resulting from ocular surface manipulations such as cataract surgery [4], long-term and improper use of contact lenses [5][6][7], and frequent exposure to irritating environmental and chemical stimuli (infection, air pollutants, hazardous chemicals, air pressure etc.) [1,8,9], can lead to local release of inflammatory mediators, including calcitonin gene-related peptide (CGRP), causing corneal inflammation [10].…”

Section: Introductionmentioning

confidence: 99%

Allosteric Cannabinoid Receptor 1 (CB1) Ligands Reduce Ocular Pain and Inflammation

et al. 2020

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Cannabinoid receptor 1 (CB1) activation has been reported to reduce transient receptor potential cation channel subfamily V member 1 (TRPV1)-induced inflammatory responses and is anti-nociceptive and anti-inflammatory in corneal injury. We examined whether allosteric ligands, can modulate CB1 signaling to reduce pain and inflammation in corneal hyperalgesia. Corneal hyperalgesia was generated by chemical cauterization of cornea in wildtype and CB2 knockout (CB2−/−) mice. The novel racemic CB1 allosteric ligand GAT211 and its enantiomers GAT228 and GAT229 were examined alone or in combination with the orthosteric CB1 agonist Δ8-tetrahydrocannabinol (Δ8-THC). Pain responses were assessed following capsaicin (1 µM) stimulation of injured corneas at 6 h post-cauterization. Corneal neutrophil infiltration was also analyzed. GAT228, but not GAT229 or GAT211, reduced pain scores in response to capsaicin stimulation. Combination treatments of 0.5% GAT229 or 1% GAT211 with subthreshold Δ8-THC (0.4%) significantly reduced pain scores following capsaicin stimulation. The anti-nociceptive effects of both GAT229 and GAT228 were blocked with CB1 antagonist AM251, but remained unaffected in CB2−/− mice. Two percent GAT228, or the combination of 0.2% Δ8-THC with 0.5% GAT229 also significantly reduced corneal inflammation. CB1 allosteric ligands could offer a novel approach for treating corneal pain and inflammation.

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Section: Introductionmentioning

confidence: 99%

Allosteric Cannabinoid Receptor 1 (CB1) Ligands Reduce Ocular Pain and Inflammation

et al. 2020

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“…[ 7 ] During topical anesthesia, patients often sensing light and color, and they even see the surgeon's hands and surgery tools,[ 8 9 ] and sense pain when manipulating the iris, stretch of the globe, and inserting the lens. [ 10 11 ] Therefore, sedation or supplemental analgesia is often required during surgery. [ 12 ]…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of fentanyl versus pethidine in cataract surgery under propofol- based sedation: A double-blind randomized controlled clinical trial

et al. 2020

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Background: The study was aimed to evaluate the safety and efficacy of fentanyl and pethidine on the sedative quality of patients who underwent phacoemulsification cataract surgery with Propofol. Materials and Methods: In this double-blind randomized controlled clinical trial, patients who were candidates for elective phacoemulsification surgery with topical anesthesia were enrolled. The selected patients were randomly allocated into the two groups for receiving sedation with Propofol-Pethidine (PP) or propofol-fentanyl (PF) combinations. Demographic characteristics, hemodynamic parameters before, during, and after the operation, sedation and pain scores, and patients' and surgeons' satisfaction scores were compared in the two studied groups. Results: In this trial, 70 patients (35 patients in each group) have completed the study. Mean (standard deviation) operation time was 22.9 (6.8) and 25.46 (7.7) minutes in PF and PP groups ( P = 0.118).Mean pain score in PF 0.46 (0.14) was significantly higher than PP groups 0.236 (0.06) ( P = 0.011). The mean value of diastolic and systolic blood pressures, pulse rate, and mean arterial pressure dioxide were significantly decreased in both PF and PP groups ( P Time < 0.001), although there was no significant difference between groups. Conclusion: Our findings indicated the equivalence effects on hemodynamic parameters for both pethidine and fentanyl in combination with propofol in which they could provide appropriate sedation and safe anesthesia with lower complications and acceptable patients' and surgeons' satisfaction.

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“…The advent of small-incision phacoemulsification allowed the majority of US ophthalmologists to transition from retro- or peri-bulbar anesthesia during cataract surgery to topical anesthesia, providing easier and less invasive application, rapid onset, and reduced postoperative rehabilitation time 1–3. Despite these advantages, topical anesthesia does not provide a completely painless procedure 4.…”

Section: Introductionmentioning

confidence: 99%

“…It may not provide adequate sensory blockade for the iris and ciliary body, leading to perioperative ocular discomfort and pain 5. Intraoperative pain often occurs not only due to direct iris manipulation and intraocular lens insertion, but also simply from movement of the iris diaphragm during intraocular fluid dynamic changes or light exposure from the operating microscope 1. In the absence of akinesia, pain and discomfort felt by the patient can lead to sudden eye movements or squeezing, increasing the risk of intraoperative complications 2,6.…”

Section: Introductionmentioning

confidence: 99%

<p>Effect Of Intracameral Phenylephrine And Ketorolac 1.0%/0.3% On Intraoperative Pain And Opioid Use During Cataract Surgery</p>

Donnenfeld

Shojaei

2019

OPTH

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PurposeTo compare the effect of Omidria (phenylephrine and ketorolac 1.0%/0.3%) vs epinephrine on pain reduction and opioid usage during cataract surgery.Patients and methodsSixty patients at a single center underwent femtosecond laser (FLACS) or conventional phacoemulsification under topical lidocaine gel anesthesia and intracameral preservative-free lidocaine 1%. Eligible participants were prospectively assigned to receive either intracameral phenylephrine and ketorolac 1.0%/0.3% or intracameral epinephrine. All patients received standardized pre- and post-operative topical therapy. Intravenous (IV) fentanyl was administered for ocular discomfort in patients who complained of intraoperative pain. Outcome measures included both pain (measured by mean visual analog scale (VAS) pain scores from 0 (no pain) to 10 (extreme pain)) and the use of IV fentanyl during surgery. A composite endpoint identified “responders” as being patients who: (1) did not require fentanyl and (2) experienced no to minimal pain (VAS score ≤ 3).ResultsForty-one patients were in the phenylephrine and ketorolac 1.0%/0.3% (study) group and 19 were in the epinephrine (control) group. Mean VAS pain scores were significantly (48.9%) lower in the study group than the control group (2.3 vs 4.5; P < 0.0001). The proportion of patients with VAS scores ≤ 3 was significantly greater in the study group (85.0%) than the control group (31.6%) (P < 0.0001). A smaller proportion of patients required intraoperative fentanyl in the study group compared to the control group (9.8% vs 42.1%; P = 0.006). For the composite endpoint, patients receiving phenylephrine and ketorolac 1.0%/0.3% were 94% less likely to require fentanyl or to have moderate-to-severe pain (pain VAS ≥ 4; OR, 0.06; 95% CI 0.02–0.24) than patients receiving epinephrine.ConclusionOur results suggest that the routine use of intracameral phenylephrine and ketorolac 1.0%/0.3% during cataract surgery can significantly reduce patient pain as well as the need for opioids.

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Intraoperative and postoperative pain in cataract surgery

Cited by 21 publications

References 96 publications

Allosteric Cannabinoid Receptor 1 (CB1) Ligands Reduce Ocular Pain and Inflammation

Allosteric Cannabinoid Receptor 1 (CB1) Ligands Reduce Ocular Pain and Inflammation

Safety and efficacy of fentanyl versus pethidine in cataract surgery under propofol- based sedation: A double-blind randomized controlled clinical trial

<p>Effect Of Intracameral Phenylephrine And Ketorolac 1.0%/0.3% On Intraoperative Pain And Opioid Use During Cataract Surgery</p>

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