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Yuna Rapoport, Amy Chomsky, Laura L Wayman; The Impact of Operative Time on Pain Control during Cataract Surgery within Different Anesthesia Modalities in a Veteran Population. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2543.
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© ARVO (1962-2015); The Authors (2016-present)
The purpose of the study is to determine if cataract operative time has an impact on pain control within different anesthesia modalities; secondarily, to determine whether some patient characteristics have an impact on operative time.
A retrospective chart review of 330 cataract surgeries within the Nashville Veterans Affairs Medical Center was completed. The cases were divided by time ( > 45 minutes and < 45 minutes). Pain scores between anesthesia modalities (topical with no sedation, topical with sedation, Retrobulbar block [RBB] and general) were analyzed between the time groups. Pain control, age, amount of sedation received, history of anxiety/ post traumatic stress disorder (PTSD), and 1st or 2nd eye surgery were analyzed between the groups. The data was then controlled for complex cases with the same markers analyzed. Two-sample t tests were used to compare means of the variables.
Of the 330 cases reviewed, 15 had general anesthesia, 146 had RBB, 53 had topical with no sedation, and 116 had topical with sedation. 174 cases were < 45 minutes, and 156 cases were > 45 minutes. Cases < 45 minutes had a lower average pain score irrespective of anesthesia type; however this was not significant. Within each anesthesia group, there was no difference in pain scores between the time groups. Cases > 45 minutes had significantly more sedation (p= 0.0003). Patients with anxiety/ PTSD had significantly longer operative times (p=0.0421). There was no difference in age or 1st or 2nd eye surgery between the time groups. When comparing complex and non-complex cases, complex cases had longer operative times (p=0.0128). However, there was not a difference in pain scores, amount of sedation received and age. Overall RBB had significantly higher pain scores when compared to the other anesthesia modalities (p=0.00943). However, when controlled for complex cases, RBB did not have higher pain scores.
Our data suggests that operative time was not associated with increased pain score. This may at least in part be due to the longer operative times receiving more sedation. This suggests that the operative team prevents and responds well to patient pain. Anxiety/ PTSD history showing increased operative time may reflect the patient needing more guidance through the operation if awake. This study is limited by its retrospective nature and sample size.
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