Abstract
Purpose: :
To determine which method of anesthesia is best for Intravitreal injections (IVT).
Methods: :
A retrospective review was done of 46 patient charts who pre-injection receivedeither Topical + Cotton pledget (TC), Topical + Gel (TG), Gel alone (G), or Topical + Subconjunctival (TS). Topical consisted of one drop of proparacaineimmediately followed by one drop of tetracaine 0.5%. Pledgets were soaked inlidocaine 4% and applied for 30 sec X 3. Gel was tetravisc 0.5% applied for 3" X 2.Subconjunctival waslidocaine 2% without epinephrine using a 30G needle. Patients were asked to separately grade the degree of pain of the anestheticdelivery itself, the injection, and pre-discharge using the Visual Analog Pain Scale.Average pain was calculated as the mean of categories 1-3. Each method was statistically compared to each other in each of the 4 categories: 1) Anesthetic delivery pain, 2) Injection pain, 3) Post-injection pain, and 4) Average overall pain.
Results: :
The Anesthesia Delivery Pain, Injection Pain, Post-Injection Pain, Average Pain; for each group was respectively;Topical + CTA, 1.22 +/- 1.80, 1.44 +/- 2.25, 0.50 +/- 1.20, 1.05 +/- 1.82Topical + Gel, 0.45 +/- 1.20, 1.00 +/- 1.35, 0.09 +/- 0.28, 0.51 +/- 1.12*Gel, 0.22 +/- 0.66, 2.44 +/- 2.70, 0.22 +/- 0.44, 0.96 +/- 1.89Topical + Sub Conj. Injection, 0.37 +/- 0.74, 0.25 +/- 0.46*, 1.00 +/- 1.60, 0.54 +/- 0**Statistically significant differences were found only between the following groups:Injection pain was less in TS vs. G, p=.019. Post-injection pain was less in TG vsTS, p=.040. Average pain was statistically less in TG vs TC, p=.048 and TS vs. TC p=.048.
Conclusions: :
Injection pain was least with Topical + Subconjunctival. Overall average pain was less in both the Topical + Subconjunctival groups andthe Topical+ Gel groups.
Keywords: injection • retina • age-related macular degeneration