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N.A. Tucker, E. Lee; Pain Associated With Eyelid Local Infiltration: A Prospective Study Comparing Standard Technique With a Computer Generated Infiltration Device . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5131.
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To evaluate the pain associated with local infiltration into the eyelid using the Wand as compared to traditional syringe infiltration technique. The Wand (Milestone Scientific, Livingston, NJ) is a delivery system that uses a microprocessor and an electric motor to precisely regulate flow rate during administration. This device has been used primarily in pediatric dentistry.
Thirty patients undergoing minor eyelid surgical proceedures requiring infiltration of local anesthetic were included in the study. Patients were randomly randomly assigned to receive local anesthetic using either the Wand, or standard infiltration technique. Those patients receiving local infiltration via the Wand were injected initially at the slow speed setting, and then using a combination of the slow and fast speed settings. Patients were masked regarding the infiltration technique used. Excluded from the study were patients who had previously undergone eyelid surgery in the region of the infiltration, surgical procedures which routinely require less that 0.5 cc of local infiltration per injection site (such as removal of skin tags, and punctoplasty). In patients with more than one lesion requiring injection of greater than 0.5ml, only the first injection was evaluated and included in the study. In each patient, the following information was obtained: patient age, sex, nature of the minor eyelid procedure, total injection volume, total duration of injection. Pain was evaluated using a visual analogue scale (0–10), and as well, the total duration of pain was recorded.
The mean pain level reported on the visual analogue scale was 1.5 in patients injected using the Wand, which was significantly lower than the mean pain level of 3.2 in patients receiving infiltration via the standard technique (p<.01). Even more striking was the difference in duration of pain reported in each group; an average of 1.5 sec in the Wand group, as compared to 34 sec in the standard technique group (p<.01). Both groups were similar in terms of the patient sex, age, injection volume, and duration of injection.
The Wand was effective at significantly reducing the pain associated with local infiltration used for minor eyelid surgery. Patients appear to feel the initial needle stick only (with a mean pain score of 1.5 lasting 1.5 seconds). In contrast, the pain associated with local infiltration using the standard technique, is more severe (mean pain score 3.2), and lasts considerably longer (average 34 seconds).
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