Pain during second eye cataract surgery under topical anesthesia: an intraindividual study.

BACKGROUND: Aim of the study was to investigate: 1) if second eye cataract surgery under topical anesthesia is more painful than surgery on the first eye, 2) if pain experienced during the procedure on the first eye may predict the pain of the second procedure, and 3) if patients' cooperation is different between the first and the second eye procedure. METHODS: Seventy-three consecutive patients undergoing bilateral non-simultaneous cataract surgery were prospectively included in the study. Surgical technique was sutureless clear corneal phacoemulsification under topical anesthesia. Immediately after surgery every patient graded the pain experienced using a visual analogue scale (VAS) from 0 (no pain) to 10 (unbearable pain). At the end of each procedure the surgeon graded patients' cooperation using a 4-point scale. RESULTS: Mean VAS score was 2.35 (SD 2.63) for the first eye and 2.89 (SD 2.93) for the second eye. Such a difference was not statistically significant (p = 0.1777, Wilcoxon test). The correlation between the VAS score of the first and that of the second procedure was statistically significant (r = 0.5514, p < 0.0001, Spearman rank correlation). Patients' cooperation was 2.64 (SD 0.63) during the first procedure and 2.52 (SD 0.79) during the second procedure; this difference was not statistically significant (p = 0.1769, Wilcoxon matched-pairs signed-ranks test). CONCLUSIONS: After uneventful cataract surgery under topical anesthesia, pain experienced and cooperation did not differ between first and second eye procedures. A correlation was found between pain scores of the first and the second eye procedures.

Efficacy of topical plus intracameral anesthesia for cataract surgery in high myopia: randomized controlled trial.

PURPOSE: To assess the efficacy of intracameral lidocaine supplementation of topical anesthesia during cataract surgery in eyes with high myopia. SETTING: Department of Ophthalmology, Ospedale San Pietro-Fatebenefratelli, Rome, Italy. METHODS: This prospective double-blind study comprised 120 highly myopic eyes with an axial length (AL) greater than 26.0 mm scheduled for routine cataract surgery. Cases were divided into 2 groups of 60 eyes each. One group received a placebo of balanced salt solution (BSS) (control group) and the other group, a supplement of 0.1 mL preservative-free lidocaine hydrochloride 1% injected in the capsular bag during hydrodissection (lidocaine group). Intraoperative pain was assessed by recording spontaneous patient reports of sensation of pain or ocular discomfort during 3 surgical stages: phaco tip insertion, irrigation/aspiration (I/A) system insertion for cortical aspiration, I/A system insertion for ophthalmic viscosurgical device removal after intraocular lens implantation. Postoperative pain was assessed on a visual analog scale (range 0 to 10). Data were compared by chi-square and Mann-Whitney U tests. RESULTS: The overall mean AL was 28.58 mm (28.57 mm control group; 28.50 mm lidocaine group). Fewer patients in the lidocaine group reported intraoperative pain, ocular discomfort, or tissue manipulation (odds ratio=0.36; 95% confidence interval, 0.16-0.80; P= .019). The mean postoperative pain score was 1.88+/-2.17 (SD) in the control group and 1.36+/-2.02 in the lidocaine group; the difference was not statistically significant (P= .21). CONCLUSION: Intracameral lidocaine supplementation for cataract surgery may improve intraoperative comfort under topical anesthesia in highly myopic eyes.

Lidocaine 2% gel versus lidocaine 4% unpreserved drops for topical anesthesia in cataract surgery: a randomized controlled trial.

OBJECTIVE: To compare intracameral levels and clinical efficacy of lidocaine 2% gel with lidocaine 4% unpreserved drops. DESIGN: Double-blind, randomized, one-surgeon, controlled trial. PARTICIPANTS: One hundred seven consecutive cataract cases eligible for topical anesthesia. INTERVENTION: Patients were randomly assigned to receive 20 mg of lidocaine either as lidocaine 2% gel (1 ml) or as lidocaine 4% unpreserved eyedrops (0.5 ml) before clear corneal phacoemulsification. MAIN OUTCOME MEASURES: Aqueous samples were taken to measure lidocaine intraocular levels. Intraoperative pain was quantified a few minutes after surgery using a 0 to 10 visual analog scale. SECONDARY OUTCOME MEASURES: Patients were asked to grade the degree to which they were bothered by tissue manipulation. The surgeon graded patients' cooperation. The anesthesiologist recorded any increase in pulse or blood pressure and the need for supplemental topical anesthesia or intravenous sedation. Duration of surgery and intraoperative complications were also recorded. RESULTS: In the gel group intracameral lidocaine levels were significantly higher (P < 0.001) and patient-reported intraoperative pain scores were significantly lower (P = 0.026). Patients in the gel group were bothered by tissue manipulation to a lesser extent (P = 0.028), and their cooperation was better (P = 0.002). Increases in blood pressure were more frequent in the eyedrops group. Supplemental anesthesia was required in two cases (3.70%) in the gel group versus eight cases in the eyedrops group (15.09%). No correlation between intracameral lidocaine levels and intraoperative pain scores was found (r = -0.026, P = 0.789). CONCLUSIONS: If administered by means of gel, the same amount of lidocaine gives significantly higher intracameral levels of lidocaine, better analgesia, better patient cooperation, and less need for intraoperative supplemental anesthesia. Lower pain scores do not correlate with intracameral lidocaine levels.