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Efstathia Kiatos, James Jacob Armstrong, Cindy ML Hutnik, Stephen Tsioros, Monali Malvankar, William Hodge; A Systematic Review and Meta-Analysis of Intravenous Sedation in Modern Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4778. doi: https://doi.org/.
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Phacoemulsification can be performed using local anesthesia techniques, along with intravenous sedation, oral sedation, or no sedation. We conducted a systematic review and meta-analysis is to assess the effectiveness of intravenous versus non-intravenous sedation methods.
The eligibility criteria included randomized controlled trials which examined intravenous versus non-intravenous sedation methods in phacoemulsification. The outcome measures were patient pain perception and perioperative complications in healthy adults. We searched Medline, Embase, CINAHL, Cochrane Library, Web of Science, BIOSIS Previews, and grey literature. Ten studies (985 participants) were included in the analysis. Data analysis was conducted using STATA 13. Meta-analyses were conducted using the standardized mean difference, weighted mean difference, and dichotomous data. Subgroup analyses were conducted to evaluate intravenous medications, and non-intravenous sedation methods. Sensitivity analyses, meta-regressions, and funnel plots were also conducted.
Results found that intravenous sedation was significantly associated with a decrease in pain when compared to non-intravenous methods (SMD = -0.86; 95% CI=1.49 - -0.23; p<0.001) (WMD = -1.01; 95% CI= -1.66 - -0.36; p=0.002). The first subgroup analysis which compared the effectiveness of intravenous medications found that fentanyl may be the most effective and reducing patient pain perception (SMD = -1.84; 95% CI= -2.22 - -1.46; p=0). The second subgroup found that intravenous sedation and oral sedation may be equivalent in in reducing patient pain (SMD=0.02; 95% CI= -0.23 - 0.27; p=0.871). The meta-analysis of perioperative complications found that intravenous sedation did not have a statistically significant increase in adverse events when compared to non-intravenous anesthesia techniques (RR=0.98; 95% CI=0.92-1.05; p=0.614).
The results indicate that intravenous sedation resulted in less pain and more comfort for patients compared to non-intravenous sedation methods, however, a subgroup analysis of a small number of studies indicated that oral sedation and intravenous sedation techniques may be equivalent in controlling patient pain. These results have potential to impact resource allocations in both publicly and privately funded environments, as switching from intravenous sedation to oral sedation can result in immense cost savings.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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