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J. Lesso-Zamora, J. Guerrero-Naranjo, J. De la Luz-Osnaya, A. Morales-Delgado, M. Martínez-Castellanos; Measurement of Pain During 23 Gauge Vitrectomy With Topical Anesthesia. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2565.
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To assess the intraoperative pain during 23 gauge vitrectomy with topical anesthesia (TA).
Experimental, transversal study. Patients scheduled for 23 gauge vitrectomy using TA and the new generation of Alcon trocars, (Alcon, Forth Worth, TX) were included. All patients accepted the procedure and signed an informed consent. Intravenous sedation with 0.5mg/Kg midazolam as a single dose was administered before the procedure. Instillation of tetracaine solution (5mg/ml) drops was performed two minutes before the procedure. A mixture of 1cc of lidocaine hydrochloride 2% and 9cc of hidroxypropilmethylcellulose 2% was prepared before surgery, and was applied over the cornea during the procedure, every time the vitrectomy lens was removed. A numeric scale of 0 to 10 was used to assed the pain where 0 equaled no pain and 10 equaled the most severe pain ever experienced by the patient.
A total of 32 consecutive patients were included. Four patients had diagnosis of macular hole (MH), six of epiretinal membrane (ERM) and 22 patients with proliferative diabetic retinopathy (PDR). The average operative time was 40 minutes (range: 18 minutes to 50 minutes). Thirty one patients (99%) reported a pain scale of three or less. Two patients with PDR graded their pain in level 3; another 25 patients graded the pain in level 2 (three with MH, four with ERM and 18 with PDR). Two patients (one with PDR and one with ERM) reported a pain scale of 1. Two patients (one with MH and other with ERM) graded a level 0 of pain. Only one patient with PDR graded the level of pain as 6, and required a subconjuntival injection of 2% lidocaine hydrochloride and an extra dose of IV midazolam to complete the procedure. Pain was experienced especially during the sclerotomies.
Topical anesthesia is a feasible option in small gauge vitreoretinal surgery with the added benefit of reducing the risk of retro or periocular complications.
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