Keywords
Intravitreal injection; Lidocaine gel; Pain; Topical anesthesia
Abstract
Purpose: Intravitreal injection (IVI) pain is controlled by various methods; none is demonstrably superior. This prospective trial compared pain in patients undergoing IVI with topical anesthesia with or without 2% lidocaine gel.
Methods: Patients over 40 years scheduled for atleast two IVIs in one eye were included. Initial anesthesia was 0.5% proparacaine/hydroxyl propyl methyl cellulose or 0.5% proparacaine/2% lidocaine gel. Patients answered questionnaires about discomfort during blepharostat positioning and IVI pain from 0-10. Thirty days later, patients received the other anesthesia for the second IVI. Corneal and conjunctival staining with lissamine green and fluoresce in was evaluated on the first post operative day using the Oxford scale.
Results: Forty patients were included, comprising 18 men and 22 women (mean age, 68.15±10.38 years). There was no significant difference in age (p=0.880) or sex (p=0.635); significance was shown between diagnostic frequencies (p < 0.001). Mean pain scores during blepharostat placement were 0.75±0.98 and 0.50±0.75 in the placebo and lidocaine groups, respectively (p=0.040); during IVI, they were 1.35±1.09 and 0.95±0.96, respectively (p=0.017). The placebo and lidocaine groups differed significantly in satisfaction; 45% and 70% were very satisfied, respectively (p=0.031). There was no significant difference between groups in regard to keratitis mean score (p=0.897) and lissamine green staining (p=0.397).
Conclusion: Lidocaine gel has important benefits over standard topical anesthetics and relieves IVI pain.
Citation
Shiroma HF, Farah ME, Novello SB, Urias M and Rodrigues EB. Intravitreal Injection Topical Anesthesia with and without 2% Lidocaine Gel. SM J Anesth. 2016; 2(1): 1005.