Pain relief with intracameral mepivacaine during phacoemulsification

Abstract

)) while remaining unchanged in the placebo group (2.9 (2.6-3.2) v 2.9 (2.5-3.3)), the mean reduction in pain score being significantly diVerent between the two groups (p<10 −4 ). There was no indication of increased postoperative ocular inflammation, intraocular pressure change, or endothelial cell loss. Conclusions-These results suggest that it may not be necessary to systematically add intracameral anaesthesia with topical anaesthesia for cataract surgery. An intraoperative intracameral injection, performed only in patients who happen to suVer during surgery, is safe and eVective. (Br J Ophthalmol 2000;84:171-174) Cataract surgery using topical anaesthesia has recently become considerably more popular. This type of anaesthesia avoids complications associated with general or locoregional anaesthesia, and seems ideally suited for ambulatory surgery in view of the preoperative and postoperative comfort oVered to the patient. Its principal drawback is intraoperative pain in 5% to 10% of the patients.

Comparison of efficacy and duration of effect on corneal sensitivity among anesthetic agents following ocular administration in clinically normal horses

“…This drug is also used topically and intracamerally in humans during cataract surgery or other ocular procedures and provides adequate desensitization of the cornea. 30,31 Although there was a reduction in corneal sensitivity following ocular application of mepivacaine solution in the horses in the present study, the anesthetic effect of this treatment was not as notable as that provided by application of each of the other anesthetic agents. The comparatively decreased efficacy of mepivacaine is most likely related to its poor corneal permeability, as shown in rabbits.…”

Topical and Intracameral Anaesthesia for Cataract Surgery

“…Reversible cellular swelling could be observed when the concentration was at least 1 % [40], with permanent damage only at 2 % [38]. Clinical and experimental studies on human corneas confirmed these results, at least for lidocaine [21,25,40,43,54,55] and mepivacaine [52]. Other compounds, like bupivacaine, seem more toxic [3].…”

“…It has been employed at the 0.50 %, 0.75 % and 2 % concentrations as topical anaesthetic for cataract surgery [17,45,52], showing low corneal epithelium toxicity. The intraocular penetration is good because bupivacaine is extremely liposoluble.…”

“…Because of its poor corneal penetration, its use in cataract surgery has been mainly limited to intraocular injections in patients showing pain after topical anaesthesia with 2 % bupivacaine [52]. In that study, intraocular irrigation with 0.4 ml of unpreserved 2 % mepivacaine solution proved to be effective in relieving pain and safe for the corneal endothelium [52].…”

“…Lidocaine 1 % is mainly prepared at surgery from 4 % solutions by diluting in BSS or BSS plus, with obtained pH of 6.39 and 7.11, respectively [13]. Other drugs tested for intracameral irrigation are bupivacaine [3,48] and mepiva-caine [52], that also proved to be effective and safe in published studies. After being delivered into the anterior chamber, a part of the anaesthetic drug is rapidly absorbed by iris, ciliary body and cornea, while the drug still present in solution is removed by subsequent anterior chamber irrigations, thus limiting tissue exposure [4].…”