Patient Pain during Intravitreal Injection under Modified Topical Anesthesia -A Comparative Study (original) (raw)
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Patient pain during intravitreal injections under topical anesthesia: a systematic review
International journal of retina and vitreous, 2017
Intravitreal injection (IVI) is a very common vitreoretinal procedure, and multiple injections are often required per patient. This systematic review was conducted to evaluate the effectiveness of various local anesthetic techniques in reducing pain during injection. A systematic review was conducted based on searches of Cochrane, LILACS, PubMed, Scopus, Web of Science, and the gray literature (Google Scholar). The end search date was February 19, 2016, across all databases. We classified pain by converting visual analog scale (VAS) scores (0-100 mm) into Jensen's classification levels: 0-4, no pain; 5-44, mild pain; 45-74, moderate pain; and 75-100, severe pain. An intervention was considered clinically significant when pain score change was >12 mm on a 100-mm scale. Eight studies out of 23 met the eligibility criteria. The total number of patients was 847. Most studies (5/8 [62.5%]) were at unclear risk of bias because of unclear randomization, thus providing only moderate ...
Topical Anesthesia with Ropivacaine and Proparacaine for Intravitreal Injection Procedures
2017
Purpose: To evaluate the efficacy of the combination of ropivacaine 0.2% plus proparacaine 0.5% for topical anesthesia in office intravitreal injection procedures and to compare it with the anesthetic efficacy of proparacaine 0.5% eye drops alone. Methods: Prospective study. We compared two different Anesthetic Methods (AM); proparacaine 0.5%+ropivacaine 0.2% (AM 1) and proparacaine 0.5% alone (AM 2). One hundred and fifty five sequential patients undergoing intravitreal injections were randomized into 1 of 3 groups: Group 1 was a crossover group in which patients undertook bilateral same-day intravitreal therapy with different anesthetic method for each eye and compared pain sensation between the two eyes. Group 2 & 3 undertook unilateral therapy, received topical anesthesia with anesthetic method 1 & 2, respectively, and were asked to grade pain sensation. A 0 to 10 pain scale representing no pain (0) to severe pain (10) was used. Results: In the first group the 38 patients (76 ey...
Purpose: To compare the anesthetic effectiveness of topical proparacaine drops, subconjunctival lidocaine, and 2% lidocaine gel. Methods: Ninety-two patients undergoing intravitreal injections were randomi- zed to 1 of 3 groups: proparacaine 0.5% drops (Group Drops), proparacaine 0.5% drops plus subconjunctival lidocaine (Group SC), or 2% lidocaine gel (Group Gel). Patients were asked to score their pain experience using a visual analog scale of 0 to 10 immediately following the injections and 10 min, 1 h, 6 h, and 24 h after the injections. Patients also graded the overall injection experience as Excellent, Very Good, Fair, Poor, or Awful. The physician evaluated the patients’ eye movement during intravitreal injection on 3 levels: (0) none or minimal, (1) not compromising the injection, and (2) compromising the injection. Results: The patients in Group Drops had the worst mean pain scores during the injection and 10 min after, with the highest occurrence of movements com- promising the procedure (Grade 2; 38.7%). The patients in Group SC had a higher percentage of good experiences (37.9%) but a higher incidence of chemosis (16.7%). The patients in Group Gel had similar overall pain scores to Group Drops patients but a higher incidence of keratitis (19.4%). There was no statistically significant correlation between the use of aspirin or anticoagulants and the occurrence of hyperemia or hyposphagma. Conclusions: Subconjunctival lidocaine was most effective in preventing pain and eye movements during intravitreal injections. Although 2% lidocaine gel produced a good overall experience for the patients, the incidence of keratitis was very high (19.4%). Therefore, we do not recommend 2% lidocaine gel as the first anesthetic choice for intravitreal injections. There is no evidence to suspend the use of aspirin or other anticoagulants drugs prior to intravitreal injections.
Ocular Pain After Intravitreal Injection*
Current Eye Research, 2013
Purpose: To evaluate the efficacy of different anesthetics and topical anti-inflammatory treatment in patients undergoing intravitreal injections (IVI). Methods: Prospective, randomized, double masked, comparative study. Patients undergoing 0.05 mL IVI were randomized to two different preoperative anesthetic regimes (regime A [0.5% tetracaine þ naphazoline] versus regime B [5% lidocaine]) and two different post-injection topical protocols (protocol 1 [tobramycin qid] versus protocol 2 [tobramycin qid þ diclofenac qid]). Patients were trained to score pain using a numerical rating pain scale from 0 (no pain) to 10 (excruciating pain) immediately after the injection, 30 min and 24 h later. Patients were instructed to take oral paracetamol (650-1000 mg, adjusted to the patient's weight) every six hours ad lib if necessary.
Saudi Journal of Anaesthesia, 2014
Background and Purpose: Today no method of topical anesthesia for intravitreal injection administration has been proven to make the patient comfortable yet. We compared the effi cacy of topical levobupivacaine 0.75% and proparacaine 0.5% in patients undergoing intravitreal injections. Materials and Methods: A prospective, randomized study comparing two agents for topical anesthesia in intravitreal injections. Ninety-six consecutive patients were enrolled into two groups to receive either topical levobupivacaine 0.75% (n=48) or proparacaine 0.5% (n=48). Patients were asked to score their pain using a visual analog scale (VAS) immediately following the injection. The average of these scores was used as the primary outcome. The surgeon performing the procedure scored his perception of the patients' pain using the Wong-Baker FACES scale. Results: Mean VAS pain scores for two groups were found to be 44.77 ± 16.42 and 34.18 ± 14.83, respectively. Mean VAS pain score in the proparacaine group was signifi cantly lower than that in the levobupivacaine group (P= 0.003). Mean Wong-Baker FACES scores for the two groups were 1.08 ± 0.49 and 1.10 ± 0.30, respectively. There was no statistically signifi cant difference between levobupivacaine and proparacaine groups (P=0.824). Conclusions: Topical proparacaine 0.5% was more effective in preventing pain during intravitreal injections.
Clinical Ophthalmology, 2011
Intravitreal injection of ranibizumab has become one of the most commonly performed ophthalmic procedures. It is timely to conduct an evaluation of the injection procedure from the patient's perspective so as to determine ways to improve patient experience. The purpose of this study was to quantitatively describe patients' experiences of the different stages of the intravitreal injection procedure and provide suggestions for improvement. Method: Following intravitreal injection, patients were administered a questionnaire to score the distress felt for each of ten parts of the whole injection process from the initial waiting to the final instillation of topical antibiotic at the end. A score of higher than 4 was regarded as significantly unpleasant. The proportion of scores above 4 for each step was used to evaluate the relative distress experienced by patients for the different parts of the procedure. Results: A total of 42 patients were surveyed. The step with the highest percentage of patients scoring more than 4 was the injection step (19%). However, cumulatively, the steps relating to the application of the drape, the speculum, and the removal of drape accounted for 53% of scores greater than 4. Conclusion: There is considerable variation in how patients tolerate different stages of the injection procedure. The needle entry was the most unpleasant step followed by the draping steps cumulatively. Use of subconjunctival anesthesia, a perforated drape, and alternative lid exclusion devices may help to improve the patient's tolerability of the procedure and experience.
Clinical Ophthalmology, 2011
Introduction: Intravitreal injection of ranibizumab has become one of the most commonly performed ophthalmic procedures. It is timely to conduct an evaluation of the injection procedure from the patient's perspective so as to determine ways to improve patient experience. The purpose of this study was to quantitatively describe patients' experiences of the different stages of the intravitreal injection procedure and provide suggestions for improvement. Method: Following intravitreal injection, patients were administered a questionnaire to score the distress felt for each of ten parts of the whole injection process from the initial waiting to the final instillation of topical antibiotic at the end. A score of higher than 4 was regarded as significantly unpleasant. The proportion of scores above 4 for each step was used to evaluate the relative distress experienced by patients for the different parts of the procedure. Results: A total of 42 patients were surveyed. The step with the highest percentage of patients scoring more than 4 was the injection step (19%). However, cumulatively, the steps relating to the application of the drape, the speculum, and the removal of drape accounted for 53% of scores greater than 4. Conclusion: There is considerable variation in how patients tolerate different stages of the injection procedure. The needle entry was the most unpleasant step followed by the draping steps cumulatively. Use of subconjunctival anesthesia, a perforated drape, and alternative lid exclusion devices may help to improve the patient's tolerability of the procedure and experience.
Pakistan Journal of Ophthalmology
Purpose: To compare the anesthetic effect of topical proparacaine hydrochloride 0.5% with sub-conjunctival lidocaine 2% for intravitreal injection of Bevacizumab. Study Design: Quasi experimental study. Place and Duration of Study: Department of Ophthalmology Fauji Foundation Hospital, Rawalpindi, from July 2017 to January 2018. Methods: Sixty 60 patients who needed intravitreal Bevacizumab were included in the study after approval from the ethical review board. Exclusion criteria were patients with conditions that could affect pain sensation, acute ocular inflammation, history of intravitreal injection, using systemic analgesic/sedatives, uncooperative patients and unable to understand the pain scale. Written informed consent was taken. Name, age, gender, diagnosis, previous intravitreal injection, hospital registration number, address and contact numbers were noted. Patients were briefed about the visual analogue scale. Patients were divided into two groups. Group A received p...
British Journal of Clinical Pharmacology, 2005
Background Cataract surgery requires prolonged anaesthesia, concomitant with permanent hydration and lubrication of the cornea, in order to provide a clear view of the operation area. Aims The primary objective of the study was to assess several formulae of a soluble ophthalmic insert: TOPICSERT [bupivacaine (Bupi) + hyaluronic acid (HA) or sodium hyaluronate] in terms of complete and long-lasting anaesthesia of the cornea. The hydration properties of HA were not assessed in this study. Methods In a prospective double-blind, cross-over, randomized study, with latin-square allocation of treatments, 16 healthy volunteers received a single dose of each formula (A, 1 mg Bupi and 0.1 mg HA; B, 0.5 mg Bupi and 0.1 mg HA; C, 1 mg Bupi and 0 mg HA, and D acting as a placebo) via the ocular route with 1 week of wash-out between each period. Corneal anaesthesia was measured using a Cochet-Bonnet esthesiometer. Results There was a statistically significant difference between treatments with regard to the main criterion (complete anaesthesia lasting at least 20 min) when general association statistics were used (Mantel-Haenzel test, P < 0.0001): 68.75% (n = 11) of subjects receiving treatment A, 37.5% (n = 6) receiving treatment B, and 87.5% (n = 14) on treatment C reached complete and satisfactory anaesthesia, while this was not achieved in any of the subjects receiving placebo. Ninety-five percent confidence intervals of the difference between treatments were as follows: treatment A vs. B (-0.03, 0.66), treatment A vs. C (-0.47, 0.10), treatment B vs. C (-0.84,-0.16). Only the difference between B and C was statistically significant (adjusted probability by the method of Bonferroni, P < 0.001). When complete anaesthesia was reached, mean (± SD) duration of anaesthesia was as follows: 20.7 (± 6.5), 15.3 (± 11.4) and 24.7 (± 7.6) min for treatments A, B, C, respectively. Conclusions Bupivacaine 1 mg seems to be the efficient and safe dose. The value of hyaluronic acid as a corneal hydration agent and used in association with bupivacaine will be the subject of further studies. Ophthalmic inserts for topical anaesthesia of the cornea