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R. Jorge, Lé. P. Cintra, L. R. Lucena, J. A. Silva, R. A. Costa, I. U. Scott; Comparative Study of Analgesic Effectiveness Using Three Different Techniques of Anesthesia for Intravitreous Injection of Bevacizumab. Invest. Ophthalmol. Vis. Sci. 2007;48(13):267.
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To compare the analgesic effectiveness of topical, subconjunctival and peribulbar anesthesia for intravitreal injection of bevacizumab.
Sixty consecutive patients undergoing their first intravitreous bevacizumab treatment were enrolled in the study. Patients were randomized into three groups according to the type of anesthesia: topical proxymetacaine eye-drops (Topical group; n=20), subconjunctival 2% xylocaine (Subconjunctival group; n=20), and peribulbar anesthesia with 2% xylocaine (Peribulbar group; n=20). Pain related to the injection and to the entire procedure using a 100-degree Visual Analog Scale as well as associated subconjunctival hemorrhagic manifestations were evaluated.
Injection-related pain was significantly lower in peribulbar group when compared with topical and subconjunctival groups (P < 0.05, Kruskal-Wallis test). There was no difference in pain score between the last two groups (P > 0.05). On the other hand, entire procedure pain was significantly higher in peribulbar group when compared with topical and subconjunctival groups (P < 0.05), with no detectable difference between the later two groups (P > 0.05). The extension of subconjunctival hemorrhage was significantly lower in topical group when compared with peribulbar and subconjunctival groups (P < 0.05), with no detectable difference between the later two groups (P < 0.05).
Although peribulbar anesthesia reduced pain at the moment of the intravitreal injection, the entire procedure was more painful compared with subconjunctival or topical anesthesia. In these later two groups, no significant difference was encountered in terms of pain scores; nevertheless, subconjunctival anesthesia led to more extensive subconjunctival hemorrhage.
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