Comparison of pain scores between patients undergoing panretinal photocoagulation using navigated or pattern scan laser systems / Comparação de graduação de dor entre os pacientes submetidos à panfotocoagulação usando sistemas de laser navegado ou de padrão de varredura

ABSTRACT Purpose: To compare the pain responses of patients with proliferative diabetic retinopathy (PDR) undergoing panretinal photocoagulation (PRP) using either pattern scan laser (PASCAL) or navigated laser photocoagulation (NAVILAS). Methods: Patients diagnosed with PDR were randomly assigned to undergo either PASCAL or NAVILAS photocoagulation treatment. PRP was performed using the multi-shot mode with a spot size of 200-400 µm and a pulse duration of 30 ms to obtain a white-grayish spot on the retina. Parameters were identical in both procedures. After 30 min of PRP application, patients were asked to verbally describe their pain perception as either "none," "mild," "moderate," "severe," or "very severe" using a verbal rating scale (VRS) and visual analog scale (VAS) by indicating a score from "0" to "10," representing the severity of pain from "no pain" to "severe pain." Results: A total of 60 eyes of 60 patients (20 females and 40 males) diagnosed with PDR were treated. The mean age of patients was 62.22 ± 9.19 years, and the mean diabetes duration was 195.47 ± 94.54 months. The mean number of laser spots delivered during PRP was 389.47 ± 71.52 in the NAVILAS group and 392.70 ± 54.33 in the PASCAL group (p=0.57). The difference in pain responses between patients in the NAVILAS and PASCAL groups was significant with regard to the mean VRS (1.10 ± 0.67 and 1.47 ± 0.69, respectively; p=0.042) and mean VAS (2.13 ± 1.17 and 2.97 ± 1.35, respectively; p=0.034) scores. Conclusions: Pain responses in patients undergoing PRP with a 30-ms pulse duration were significantly milder in the NAVILAS group than in the PASCAL group.

RESUMO Objetivo: Comparar as respostas de dor de pacientes com retinopatia diabética proliferativa (PDR) submetidos à panfotocoagulação retiniana (PRP) usando laser de padrão de varredura (PASCAL) ou fotocoagulação navegada a laser (NAVILAS). Métodos: Pacientes com diagnóstico de PDR foram aleatoriamente designados para submeter-se ao tratamento de fotocoagulação com PASCAL ou NAVILAS. A PRP foi realizada no modo "multi-shot" com diâmetro do laser de 200-400 µm e duração do pulso de 30 ms, utilizados para se obter uma mancha branca-acinzentada na retina. Os parâmetros foram idênticos em ambos os procedimentos. Após 30 minutos da PRP, os pacientes foram solicitados a descrever verbalmente a sua percepção da dor como quer "nenhuma," "leve," "moderada," "intensa" ou "dor muito intensa" por meio de uma escala de avaliação verbal (VRS) e também por meio de uma escala visual analógica (VAS), indicando uma pontuação de "0" a "10" representando a intensidade da dor de "nenhuma dor" a "dor intensa." Resultados: Um total de 60 olhos de 60 pacientes (20 mulheres e 40 homens) com diagnóstico de PDR foram tratados. A média de idade dos pacientes foi de 62,22 ± 9,19 anos e a média de duração da diabete foi 195.47 ± 94,54 meses. O número médio de pulsos de laser emitidos durante a PRP foi 389,47 ± 71,52 no grupo NAVILAS e 392,70 ± 54,33 no grupo PASCAL (p=0,57). A diferença nas respostas de dor entre os pacientes nos grupos NAVILAS e PASCAL foi significativa em relação às médias de VRS (1,10 ± 0,67 e 1,47 ± 0,69; p=0,042) e VAS (2,13 ± 1,17 e 2,97 ± 1,35; p=0,034). Conclusões: As respostas de dor em pacientes submetidos à PRP com pulsos de 30 ms de duração foram significativamente menores nos pacientes do grupo NAVILAS em relação ao grupo PASCAL.

Analgesia preemptiva com dipirona versus ibuprofeno na fotocoagulação a laser da retina / Preemptive analgesia of metamizole versus ibuprofen in retinal laser photocoagulation

RESUMO Objetivo: Comparar a efetividade da dipirona versus o ibuprofeno para a redução da dor na fotocoagulação da retina (FR). Método: Foi realizado um estudo controlado, duplo cego e randomizado englobando trinta e quatro pacientes com retinopatia diabética separados em dois grupos. Grupo A recebeu 1000mg de dipirona e o grupo B recebeu 600mg de ibuprofeno. A dor foi avaliada pela escala visual analógica. Resultado: A média do escore da dor nos grupos A e B foi de 5,2 ± 2.6 e 4,5 ± 1,4, respectivamente. Não houve diferença estatística entre os grupos (p=0,34). O mesmo foi observado quanto à analise entre dor leve, moderada e grave (p=0,09). Os grupos foram semelhantes quanto à idade e sexo. Conclusão: Os medicamentos foram equivalentes ou equipotentes em reduzir a dor ocular durante a fotocoagulação a laser da retina.

ABSTRACT Objective: To compare the effectiveness of metamizole versus ibuprofen for the reduction of pain in retinal photocoagulation (RP). Method: A double-masked randomized controlled study was performed. Thirty-four patients with diabetic retinopathy were enrolled. The patients were randomized into two groups. Group A received oral 1000 mg metamizole. Group B received an oral intake of 600 mg ibuprofen. Pain during RP was assessed using a visual analog scale. Results: The mean pain scores for groups A and B were 5.2±2.6 and 4.5±1.4 (p=0.34). There were no significant differences in the mean pain scores between the two groups. The same is observed when analyzing by low, medium and high pain (p=0.09). The groups were similar in age and gender. Conclusion: Both drugs were equivalents or equipotent in reduce ocular pain during retinal photocoagulation.

Oral glucose for pain relief during examination for retinopathy of prematurity: a masked randomized clinical trial

OBJECTIVE: Ophthalmologic examination for retinopathy of prematurity is a painful procedure. Pharmacological and non-pharmacological interventions have been proposed to reduce pain during eye examinations. This study aims to evaluate the analgesic effect of 25% glucose using a validated pain scale during the first eye examination for retinopathy of prematurity in preterm infants with birth weight <1,500 g and/or gestational age <32 weeks. METHODS: A masked, randomized clinical trial for one dose of 1 ml of oral 25% glucose solution 2 minutes before the first ophthalmologic examination for retinopathy of prematurity was conducted between March 2008 and April 2010. The results were compared to those of a control group that did not receive oral glucose solution. Pain was evaluated using a Neonatal Infant Pain Scale immediately before and immediately after the ophthalmologic examination in both groups. Clinicaltrials.gov: NCT00648687 RESULTS: One hundred and twenty-four patients who were examined for the first time for retinopathy of prematurity were included. Seventy were included in the intervention group and 54 in the control group. The number of patients with pain immediately before the procedure was similar in both groups. The number of patients with pain after ophthalmologic examination was 15.7% in the intervention group and 68.5% in the control group (p<0.001). CONCLUSIONS: One ml of oral 25% glucose solution given 2 minutes before an ophthalmologic examination for retinopathy of prematurity was an effective measure for pain relief.