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Analgesic effect of supplemental intracameral lidocaine during phacoemulsification under topical anaesthesia: a randomised controlled trial
  1. Colin S H Tan1,2,
  2. Han-Bor Fam1,2,
  3. Wee-Jin Heng1,2,
  4. Hung-Ming Lee1,2,
  5. Seang-Mei Saw3,
  6. Kah-Guan Au Eong4
  1. 1Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
  2. 2National Healthcare Group Eye Institute, Singapore
  3. 3Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  4. 4Singapore International Eye Cataract Retina Center, Singapore
  1. Correspondence to Dr Colin S H Tan, Department of Opthalmology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; colintan_eye{at}yahoo.com.sg

Abstract

Aims To determine the analgesic effect of supplemental intracameral lidocaine 1% during phacoemulsification under topical anaesthesia, and to assess the risk factors associated with pain.

Methods In a double-masked, randomised, clinical trial, 506 patients undergoing phacoemulsification under topical anaesthesia were randomised to receive a supplemental intracameral injection of either 0.5 cc of 1% lidocaine (277 patients, 54.7%) or balanced salt solution (BSS) (229 patients, 45.3%). Patients were interviewed by a trained interviewer using a standardised questionnaire. The main outcome measure was intraoperative pain, scored on a visual analogue scale of 0–10. Logistic regression was performed to assess ORs.

Results 125 of 277 patients (45.1%) experienced pain in the lidocaine group, compared with 123 of 229 patients (53.7%) in the BSS group. The proportion of patients who experienced pain was significantly lower in the intracameral lidocaine group compared with the BSS group (multivariate OR 0.68, 95% CI 0.47 to 0.97; p=0.034). The median pain score (range) was 0.0 for intracameral lidocaine group compared with 1.0 for BSS group (p=0.039). Pain was more common in females (54.3% vs 43.6%; OR 1.56), non-Chinese (62.3% vs 46.9%; OR 2.13) and those who had previous cataract surgery to the fellow eye (55.3% vs 44.7%; OR 1.61).

Conclusion The use of 0.5 cc of 1% intracameral lidocaine during phacoemulsification under topical anaesthesia significantly reduces pain experienced by patients. Risk factors for pain include females, non-Chinese and previous cataract surgery.

  • Lidocaine
  • phacoemulsification
  • pain
  • intracameral anaesthesia
  • lens and zonules
  • drugs
  • treatment surgery

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Footnotes

  • This paper was presented at the American Academy of Ophthalmology Annual Meeting, 10–14 November 2006, Las Vegas, Nevada, USA.

  • Funding This study was funded by a Tan Tock Seng Hospital small project research grant.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the National Healthcare Group, Singapore.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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