May 2008
Volume 49, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2008
Comparison of Anaesthetic Methods for Phacoemulsification Using the McGill Pain Questionnaire
Author Affiliations & Notes
  • W. E. Adams
    Sunderland Eye Infirmary, Sunderland, United Kingdom
  • D. Vaideanu
    Sunderland Eye Infirmary, Sunderland, United Kingdom
  • S. G. Fraser
    Sunderland Eye Infirmary, Sunderland, United Kingdom
  • R. W. D. Bell
    Sunderland Eye Infirmary, Sunderland, United Kingdom
  • Footnotes
    Commercial Relationships  W.E. Adams, None; D. Vaideanu, None; S.G. Fraser, None; R.W.D. Bell, None.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science May 2008, Vol.49, 5670. doi:https://doi.org/
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      W. E. Adams, D. Vaideanu, S. G. Fraser, R. W. D. Bell; Comparison of Anaesthetic Methods for Phacoemulsification Using the McGill Pain Questionnaire. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5670. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : To assess pain perception between topical, sub-Tenon’s and peribulbar anaesthesia for phacoemulsification surgery using the short form McGill Pain Questionnaire (SF-MPQ). The SF-MPQ is a validated, accepted instrument which assesses sensory and affective components of pain, present pain intensity(PPI) and a visual analogue scale (VAS).

Methods: : 303 patients undergoing their first cataract surgery by phacoemulsification were randomised to receive either topical oxybuprocaine 0.4% drops (100 patients) or injected peribulbar 2% lidocaine with 1 in 200000 epinephrine plus bupivocaine 0.75% (98 patients) or injected sub-Tenon’s lidocaine 2% with 1 in 200000 epinephrine plus bupivocaine 0.75% (105 patients). Phacoemulsification was performed by the same surgeon throughout. Patients scored the severity of the components of their pain by verbal responses to the SF-MPQ, administered by a masked investigator at two separate time points, immediately following anaesthetic administration and immediately post-operatively. Total pain score was defined as the sum of the sensory score and affective score, yielding a total of 0 to 45. The present pain intensity (0-5) and VAS scale (0-10) were reported separately. Pain scores were compared between groups.

Results: : For anaesthetic administration alone, total pain scores were similar between peribulbar and sub-Tenon’s anaesthetic (mean 2.6 + 3.3 vs 2.1 + 2.9, p= 0.08) but both were higher than with topical drops (1.0 + 0.9, p<0.001 and 0.03). For the surgical procedure, total pain scores were similar between peribulbar and sub-Tenon’s anaesthetic (mean 0.4 + 1.5 vs 0.2 + 0.6, p= 0.6), but both lower than with topical drops (1.5 + 3.6, p=0.0005 and p<0.0001).The present pain intensity score (0-5) was not sensitive enough to detect a difference between anaesthetic methods for either administration of anaesthetic or the surgical procedure (p=0.09 and 0.2). The VAS confirmed more pain during surgery with topical anaesthetic than with peribulbar. (0.32 + 1.03 vs 0.03 + 0.17, p=0.003).

Conclusions: : Administration of anaesthetic by injection, via peribulbar and sub-Tenon’s routes, prior to phacoemulsification is more uncomfortable for the patient than topical drops. Nevertheless, for the surgical procedure, peribulbar and sub-Tenon’s anaesthetic yield significantly greater intraoperative comfort. Anaesthetic options should be discussed with the patient before surgery to allow an informed patient choice.

Clinical Trial: : www.ISRCTN.org ISRCTN19439616

Keywords: small incision cataract surgery • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • cataract 
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