Patient pain during different stages of phacoemulsification using topical anesthesia

O’Brien, Paul D.; Fulcher, Tim; Wallace, David E.; Power, William

doi:10.1016/s0886-3350(00)00757-4

Cited by 40 publications

(28 citation statements)

References 13 publications

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“…In our study, overall pain score was found to be 0.40 using a scale between 0 and 4. A previous paper [9]reported a mean pain score of 1.46 over a scale ranging from 0 to 10, which is fairly similar to our result. In that study, the most painful stage was phacoemulsification, followed by IOL insertion and irrigation-aspiration.…”

Section: Discussionsupporting

confidence: 92%

Subjective Visual Experience and Pain Level during Phacoemulsification and Intraocular Lens Implantation under Topical Anesthesia

Yaylalı¹,

Yıldırım²,

Tatlıpınar³

et al. 2003

Ophthalmologica

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Purpose: To investigate the subjective visual experiences and pain during the phacoemulsification and intraocular lens (IOL) implantation under topical anesthesia, and whether these parameters change according to the stage of phacoemulsification cataract surgery. Methods: Forty eyes of 40 patients with cataract undergoing phacoemulsification and IOL implantation under topical anesthesia were included in this study. The patients were told that they would be asked about their visual experiences and pain level, if any, during every stage of the surgery. As for degree of the pain, a 5-grade scale was used. The surgery was divided into 9 stages, i.e., clear corneal incision, continuous curvilinear capsulorhexis, side-port incisions at 3 and 9 o’clock positions, hydrodissection, nuclear rotation, phacoemulsification, bimanual irrigation and aspiration, IOL implantation, apposition of corneal incisions with stromal hydration. Results: All subjects (100%) reported that they had seen some kind of light during the operation. Thirty-eight patients (95%) said that they had seen one or more colors. In 32 patients (80%), the light intensity decreased, and colors blurred significantly following the hydrodissection. As for the pain level during surgery, the overall pain score was found to be 0.40. The highest mean pain score was noted during IOL implantation stage followed by phacoemulsification and bimanual irrigation-aspiration. Conclusion: Topical anesthesia is both a safe and effective method for small-incision clear corneal phacoemulsification cataract surgery. Patients may experience visual sensations, and the pain felt during the operation is low and tolerable. Visual experiences and pain level may change according to the stage of phacoemulsification cataract surgery.

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Section: Discussionsupporting

confidence: 92%

Subjective Visual Experience and Pain Level during Phacoemulsification and Intraocular Lens Implantation under Topical Anesthesia

Yaylalı¹,

Yıldırım²,

Tatlıpınar³

et al. 2003

Ophthalmologica

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“…25 As we know, some manipulations performed during phacoemulsification cause significant levels of pain. O'Brien et al 1 showed that hydrodissection, phacoemulsification, lens aspiration, and intraocular lens insertion require the most manipulation of the iris and were associated with higher pain scores during surgery. In our study most patients in the levobupivacaine and ropivacaine groups reported either no pain or mild discomfort during all surgical stages per-operatively which implies high efficiency of these agents.…”

Section: Discussionmentioning

confidence: 99%

Comparative clinical trial of topical anaesthetic agents for cataract surgery with phacoemulsification: lidocaine 2% drops, levobupivacaine 0.75% drops, and ropivacaine 1% drops

Borazan

Karalezlı

Akova

et al. 2007

Eye

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Purpose To assess the safety and efficacy of topical lidocaine, levobupivacaine, and ropivacaine in cataract surgery with phacoemulsification. Methods One hundred and five patients scheduled for cataract surgery with topical anaesthesia were randomly allocated into 3 groups of 35 patients each to receive eye drops of lidocaine 2%, levobupivacaine 0.75%, or ropivacaine 1% every 5 min starting 30 min before surgery. Patients graded their pain using a 0-10-point verbal pain score (VPS) at different stages of the procedure. The levels of patient and surgeon satisfaction, the duration of surgery, complications, and the need for supplemental anaesthesia were recorded. Results There was no significant difference in duration of surgery and demographic variables among the groups. At the intraoperative period, end of surgery, and postoperative first hour the mean VPS in the lidocaine group was significantly higher than the others (Po0.01), but no significant difference was found between the levobupivacaine and ropivacaine groups. At incision and 24 h after surgery, it was not significantly different among the groups. Surgeon and patient satisfaction scores were significantly better in the levobupivacaine and ropivacaine groups than in the lidocaine group (Po0.01).Conclusions Topical anaesthesia with levobupivacaine and ropivacaine were safe, feasible and more effective than lidocaine in cataract surgery. Levobupivacaine and ropivacaine provided sufficient and long-lasting analgesia without the need of supplemental anaesthesia for each patient.

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“…Entretanto, movimentos oculares súbitos podem ocorrer, aumentando a incidência de complicações, especialmente se o paciente não for cooperativo, ou se a cirurgia estiver sendo conduzida por um cirurgião inexperiente. Mesmo cirurgiões experientes (37) relataram dificuldade per-operatória na realização da facoemulsificação em 6% dos casos operados sob anestesia tópica, devido à movimentação ocular excessiva. Entretanto, não houve complicações secundárias a esses movimentos.…”

Section: ) Optar Pela Forma De Anestesia Mais Seguraunclassified

O professor e o estudante na facoemulsificação: os dez princípios para o sucesso

Ghanem¹,

Mannis²

2003

Arq. Bras. Oftalmol.

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Neste texto, os autores apresentam os diferentes aspectos do aprendizado da cirurgia de facoemulsificação pelo cirurgião iniciante. Discutem também o papel do professor e do aluno no ambiente da "Sala de Aula Cirúrgica", sugerindo alguns princípios que melhor fundamentam o aprendizado cirúrgico, reduzindo complicações e proporcionando maior segurança para o paciente. Gawande, Metropolitan Books, New York, 2002] O ensinamento cirúrgico representa um desafio, tanto para o orientador, que leva à sala cirúrgica sua experiência e o conhecimento de como lidar com as situações inesperadas, quanto para o cirurgião iniciante, que está meramente tentando aprender os passos básicos de um procedimento. O cirurgião iniciante deve não apenas compreender os problemas intelectuais e cognitivos que fundamentam um procedimento cirúrgico, mas, também, dominar os aspectos técnicos, com treinamento freqüente no ambiente cirúrgico. Diferente de outras funções cognitivas da medicina, a obtenção bem sucedida da habilidade cirúrgica requer experiência prática, preferencialmente sob supervisão de um cirurgião experiente.Por outro lado, o paciente que vai a uma sala de cirurgia quer estar confiante nas mãos de um cirurgião, na certeza de que o médico saberá realizar a cirurgia proposta e, conseqüentemente, não lhe causará dano algum. Isso representa um dilema para o estudante e para o professor. Este deve ter muito equilíbrio na hora de permitir ao cirurgião iniciante familiarizar-se com os passos cirúrgicos (habilidade de julgamento e experiência técnica) e, ao mesmo tempo, proteger o paciente dos erros da inexperiência. Essa decisão se torna ainda mais importante no contexto da facoemulsificação, procedimento seqüencial interdependente em que há pouco lugar para erro.Neste texto, temos como objetivo prover, a estudantes e docentes de facoemulsificação, diretrizes que poderão facilitar o aprendizado do novo cirurgião e proporcionar maior segurança para o paciente.

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Patient pain during different stages of phacoemulsification using topical anesthesia

Cited by 40 publications

References 13 publications

Subjective Visual Experience and Pain Level during Phacoemulsification and Intraocular Lens Implantation under Topical Anesthesia

Subjective Visual Experience and Pain Level during Phacoemulsification and Intraocular Lens Implantation under Topical Anesthesia

Comparative clinical trial of topical anaesthetic agents for cataract surgery with phacoemulsification: lidocaine 2% drops, levobupivacaine 0.75% drops, and ropivacaine 1% drops

O professor e o estudante na facoemulsificação: os dez princípios para o sucesso

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