A comparison of patient comfort during cataract surgery with topical anesthesia versus topical anesthesia and intracameral lidocaine

doi:10.1016/S0161-6420(99)90007-6

Ophthalmology

Volume 106, Issue 1, 1 January 1999, Pages 60-66

Presented at the American Academy of Ophthalmology annual meeting, San Francisco, California, October 1997.

https://doi.org/10.1016/S0161-6420(99)90007-6 Get rights and content

Abstract

Objective

To determine whether intraocular lidocaine increases patient comfort during cataract surgery while under topical anesthesia.

Design

Prospective, randomized, double-masked, placebo-controlled clinical trial.

Participants

Both men and women between 45 and 85 years of age who were scheduled for elective cataract surgery while under topical anesthesia participated. Sixty-eight patients were randomized to each group.

Intervention

Patients were randomized to receive either topical anesthesia plus intracameral 1% preservative-free lidocaine or intracameral balanced salt solution.

Main outcome measures

Patient assessment of pain during delivery of the anesthesia, surgery, and after surgery using a visual analog pain scale was measured. Patients also recorded the degree to which they were bothered by tissue manipulation and the microscope light. Surgeon assessments of operative conditions, patient cooperation, and intraoperative complications were recorded. The attending anesthesiologist recorded any required supplemental intravenous sedation and any increase in pulse or increase in blood pressure.

Results

There was no significant difference in patient-reported pain scores for delivery of anesthesia (P = 0.902), surgery (P = 0.170), or after surgery (P = 0.680). Patients in the lidocaine group reported being less bothered by tissue manipulation (P = 0.021). The surgeon assessment showed more patient cooperation in the lidocaine group (P = 0.043).

Conclusions

Both topical anesthesia alone and topical anesthesia plus intracameral lidocaine provide good operative conditions for the surgeon and comfortable surgical circumstances for the patient. Injection of intraocular lidocaine increases patient cooperation and decreases the degree to which patients are bothered by tissue manipulation, two outcomes that justify its use.

Section snippets

Rabbit studies

Approval was received from the Institutional Animal Care and Use Committee at the University of Utah. Twenty-five New Zealand white rabbits were anesthetized with ketamine (50 mg/kg) and xylazine (7 mg/kg) at a mixture of 7 to 1, respectively. A 75-super-sharp blade was used to make a stab incision into the anterior chamber of the right eye. A tuberculin syringe with a 30-gauge cannula was used to inject 0.25 ml of 1% preservative-free lidocaine (pH 6.5) (Abbott Laboratories, North Chicago, IL)

Rabbit studies

Each of the 25 eyes in the 2 groups was successfully treated, harvested, and analyzed. Of the 25 eyes treated with 1% preservative-free intraocular lidocaine for 10 minutes, the average endothelial damage was 8.1 ± 5.6%. The 25 eyes in the BSS control group showed an average endothelial damage of 8.4 ± 6.1%. This difference was not statistically significant (P = 0.43).

Human studies

Sixty-eight patients were entered into each group. The surgical conditions and complications are given in Table 1. The surgeon

Discussion

Our original study comparing topical anesthesia for cataract surgery with traditional retrobulbar injection anesthesia convincingly showed that topical anesthesia provided safe operating conditions and good patient comfort.26 Visual analog intraoperative pain scores for the 69 patients in the topical anesthesia group averaged 1.13, with 57 patients recording a score of 0 or no pain at all.26 This was not significantly different (P = 0.35) from the intraoperative pain scores recorded by the

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Comparison of changes in blood pressure in phacoemulsification cataract surgery performed via topical and peribulbar anaesthesia: A cohort study
2023, Medical Journal Armed Forces India
The purpose of study was to compare the changes in blood pressure in patients undergoing phacoemulsification cataract surgery under topical and peribulbar anaesthesia during preoperative, intraoperative and postoperative period.
In this prospective cohort study, 240 patients undergoing phacoemulsification were divided into topical (Group 1) and peribulbar (Group 2) equally. Proparacaine 0.5% drops were used for topical anaesthesia, and Inj lignocaine with Inj bupivacaine were used to give peribulbar anaesthesia. Preoperative blood pressure was taken 30 min before surgery with automated sphygmomanometer. Intraoperative blood pressure was taken during phacoemulsification, and postoperative blood pressure was taken 1 h after surgery. Outcomes assessed were systolic, diastolic and mean blood pressure.
Systolic blood pressure in Group 1 was significantly increased in the intraoperative phase, whereas it was significantly decreased in Group 2 in the intraoperative phase. Diastolic and mean blood pressure in Group 1 showed no significant change, whereas in Group 2, both showed significant reduction in intraoperative and postoperative phases.
The increase in intraoperative systolic blood pressure in topical group could be due to discomfort from microscope light, iris manipulation, irrigation and aspiration during surgery. The decrease in intraoperative systolic and diastolic blood pressure in peribulbar group could be due to systemic absorption of local anaesthetic. The mean preoperative systolic blood pressure was also higher in the topical group, which could be due to anxiety or stress under topical anaesthesia. The changes in blood pressure need to be observed so that timely intervention can be made to achieve favourable postoperative outcome.
0.1% Nepafenac reduces pain and increases patient comfort during cataract surgery
2018, Contact Lens and Anterior Eye
To evaluates analgesic effectiveness of 0.1% nepafenac during cataract surgery.
This prospective randomized randomized double-masked, placebo-controlled study comprised 80 eyes of 40 consecutive patients who underwent bilateral cataract surgery and implantation of foldable intraocular lens with topical anesthesia with and without topical nepafenac drops. Each eye of patients was assigned to group 1 and group 2. Topical anesthesia combined with 0.1% nepafenac used three times a day the day before the surgery and once half an hour just before the surgery was group 1, consisting of 40 eyes, and topical anesthesia with using placebo was group 2 consisting of 40 eyes. Patients were asked to score their pain using a visual analog scale (VAS) and verbal pain scale (VPS) immediately following the surgery. When the patient moved or squeeze the eye during surgery, the surgical comfort was evaluated as bad and otherwise, it was evaluated as good.
When the intensity of pain during the surgery was evaluated, the percentage of patients reporting mild or no pain in group 1 was %825 and in group 2 was %45. Mean VAS pain score and mean VPS pain score in group 1 was significantly lower than that in group 2(p = 0.024, p < 0.001). Surgical comfort in group 1 was %825 and in group 2%65(P = 0.075).
0.1% nepafenac reduces pain of patients who undergone routine clear corneal phacoemulsification with topical anesthesia and may increase patient comfort during the surgery when used preoperatively.
Ocular tolerance in rabbits after intracameral administration of a fixed combination of tropicamide, phenylephrine, and lidocaine with and without rinsing
2017, Journal of Cataract and Refractive Surgery
To evaluate the safety and tolerability of a single intracameral administration of a combined mydriatic (tropicamide and phenylephrine) and anesthetic (lidocaine) formulation (Mydrane) with or without rinsing.
Iris Pharma, La Gaude, France.
Experimental study.
Sixty pigmented rabbits received 100 μL or 200 μL of the combination product or a placebo (sodium chloride 0.9%) by intracameral injection. For the combination product, separate groups were included with and without rinsing after administration. From day 1 day to day 7, assessments included general clinical and ocular observations, pupil diameter measurements, corneal assessments, confocal microscopy, and electroretinography (ERG). Necropsy examinations were performed at study completion at day 8.
Rapid mydriasis, stable 24 minutes after injection and returning to baseline levels by day 1, was induced in all groups that received the combination mydriatic and anesthetic drug. Rinsing had no effect. The combination product induced no adverse effects on the anterior or posterior segment of the eye (ie, no increased corneal thickness and endothelial cell loss, no abnormalities in ERG). Slitlamp examination showed slightly increased anterior chamber inflammation with rinsing in both the study group and placebo group. This observation was not confirmed by aqueous flare examination. No toxic effects of the products were found on histological evaluation.
The combination mydriatic and anesthetic drug administered to pigmented rabbits as a single intracameral injection at volumes of 100 μL and 200 μL was well tolerated with no ocular adverse effects and no effect on the corneal endothelium.
Oral diazepam versus intravenous midazolam for conscious sedation during cataract surgery performed using topical anesthesia
2015, Journal of Cataract and Refractive Surgery
To compare the intraoperative pain, anxiety, undesired movement, and cooperation between patients receiving oral diazepam or intravenous (IV) midazolam for conscious sedation during cataract surgery under topical anesthesia.
Ambulatory surgical center, Honolulu, Hawaii, USA.
Prospective randomized controlled trial.
Patients having first-time cataract extraction with topical anesthesia were randomized to receive sedation with oral diazepam 30 minutes before surgery or IV midazolam immediately preceding surgery. The outcomes of intraoperative pain, anxiety, undesired movement, and poor cooperation were observed by the surgeon and recorded during surgery.
One hundred fifty-six cataract surgeries were included, 83 in the IV midazolam group and 73 in the oral diazepam group. Twenty-four patients (29%) in the IV group and 7 patients (10%) in the oral group showed undesired movement (P < .02). Seven patients (8%) in the IV group and 2 patients (3%) in the oral group showed poor cooperation (P > .05). Fifteen patients (18%) in the IV group and 9 patients (12%) in the oral group had anxiety (P > .05). Three patients (4%) in the IV group and 3 patients (4%) in the oral group experienced pain (P > .05).
Fewer patients receiving oral diazepam 30 minutes before cataract surgery than patients receiving IV midazolam immediately preceding surgery showed undesired movement during surgery. There was no statistically significant difference in the number of patients showing poor cooperation or experiencing pain or anxiety between the 2 groups.
No author has a financial or proprietary interest in any material or method mentioned.
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2015, Glaucoma: Second Edition
Intraoperative and postoperative pain in cataract surgery
2018, Survey of Ophthalmology
Citation Excerpt :
Other studies have also shown it provides increased patient cooperation and reduced sensation of procedure steps when topical modalities are selected as the primary anesthesia choice.20,30,40,103 In comparison studies, intracameral anesthesia has not shown significant benefit in reducing postoperative pain.20,64 An intraoperative adjunctive analgesic modality that was USA Food and Drug Administration–approved May 2014, is Omidria (Omeros, Seattle, WA), a combination intracameral injection of phenylephrine and ketorolac.
Technologic improvements in cataract surgery have not only improved visual outcomes, but also have minimized intraoperative and postoperative pain. We review the mechanisms, risk factors, and management of intraoperative and postoperative pain. Summaries of less common sources of physiologic pain have been included to reinforce recognition of when pain represents an expected physiologic reaction to surgery as opposed to signaling a more serious complication. We also discuss various current and emerging anesthetic and analgesic modalities.

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^☆: Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York, to the Department of Ophthalmology, University of Utah, Salt Lake City, Utah.

¹: The authors have no proprietary interests in any product mentioned in this article.

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A comparison of patient comfort during cataract surgery with topical anesthesia versus topical anesthesia and intracameral lidocaine1☆,

Abstract

Objective

Design

Participants

Intervention

Main outcome measures

Results

Conclusions

Section snippets

Rabbit studies

Rabbit studies

Human studies

Discussion

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

Ophthalmology

Ophthalmology

Surv Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

A comparison of patient comfort during cataract surgery with topical anesthesia versus topical anesthesia and intracameral lidocaine¹☆,