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M. J. Davis, J. S. Pollack; Patient Assessment of Topical Anesthetic Effectiveness for Intravitreal Injections. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5126.
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To determine whether patients undergoing intravitreal injection perceive a difference in anesthetic effect between topical proparacaine HCL 0.5%, proparacaine HCL 0.5% + topical 4% lidocaine solution, or 3.5% lidocaine gel, and whether this difference impacts their assessment of their overall injection experience.
In this prospective study, 120 sequential patients undergoing 30 and 33 Gauge intravitreal injections were randomly assigned to receive either: proparacaine HCL 0.5% (Group 1), proparacaine HCL 0.5% + 4% lidocaine liquid drops (Group 2); or 3.5% lidocaine gel (Group 3) as topical anesthetic prior to injection. All procedures utilized a lid speculum and 5% povidone iodine. Approximately 10 seconds after injection, patients graded pain associated with the lid speculum, the needle, and with burning sensation on a pain scale of 0 to 10, with 0 representing no pain and 10 representing the patient’s worst imaginable pain. They also graded their overall injection procedure experience as Excellent, Very Good, Fair, Poor, or Awful.
Each group contained 40 (33.3%) patients. Ninety-eight (81.7%) patients had an injection with a 30-gauge needle, while 22 (18.3%) had an injection with a 32-gauge needle. The average [range] lid speculum pain score for Group 1 was 0.85 [0-4], Group 2 was 0.50 [0-4], and Group 3 was 0.65 [0-4] (p=0.32). The average [range] needle pain score for Group 1 was 1.78 [0-7], Group 2 was 1.75 [0-6], and Group 3 was 1.48 [0-7] (p=0.38). The average [range] burning pain score for Group 1 was 1.45 [0-6], Group 2 was 1.58 [0-6], and Group 3 was 1.13 [0-6] (p=0.23). Overall satisfaction was rated as Excellent or Very Good in 95% of Group 1 patients, 97.5% of Group 2 patients, and 92.5% of Group 3 patients (p=0.64).
Proparacaine, proparacaine + 4% lidocaine drops, and 3.5% lidocaine gel appear to be equally effective for pain control during intravitreal injections. There is high patient satisfaction with all three anesthetics. Proparacaine drops alone appear to be an efficient and cost-effective alternative to both 3.5% lidocaine gel and combined proparacaine + 4% lidocaine solution.
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