Comparison of 3 different anesthetic approaches for intravitreal injections: a prospective randomized trial.

PURPOSE: To compare the anesthetic effectiveness of topical proparacaine drops, subconjunctival lidocaine, and 2% lidocaine gel. METHODS: Ninety-two patients undergoing intravitreal injections were randomized to 1 of 3 groups: proparacaine 0.5% drops (Group Drops), proparacaine 0.5% drops plus subconjunctival lidocaine (Group SC), or 2% lidocaine gel (Group Gel). Patients were asked to score their pain experience using a visual analog scale of 0 to 10 immediately following the injections and 10 min, 1 h, 6 h, and 24 h after the injections. Patients also graded the overall injection experience as Excellent, Very Good, Fair, Poor, or Awful. The physician evaluated the patients' eye movement during intravitreal injection on 3 levels: (0) none or minimal, (1) not compromising the injection, and (2) compromising the injection. RESULTS: The patients in Group Drops had the worst mean pain scores during the injection and 10 min after, with the highest occurrence of movements compromising the procedure (Grade 2; 38.7%). The patients in Group SC had a higher percentage of good experiences (37.9%) but a higher incidence of chemosis (16.7%). The patients in Group Gel had similar overall pain scores to Group Drops patients but a higher incidence of keratitis (19.4%). There was no statistically significant correlation between the use of aspirin or anticoagulants and the occurrence of hyperemia or hyposphagma. CONCLUSION: Subconjunctival lidocaine was most effective in preventing pain and eye movements during intravitreal injections. Although 2% lidocaine gel produced a good overall experience for the patients, the incidence of keratitis was very high (19.4%). Therefore, we do not recommend 2% lidocaine gel as the first anesthetic choice for intravitreal injections. There is no evidence to suspend the use of aspirin or other anticoagulants drugs prior to intravitreal injections.

Comparison of 3 different anesthetic approaches for intravitreal injections: a prospective randomized trial / Comparação de três abordagens anestésicas diferentes para injeções intravítreas: um estudo prospectivo e randomizado

Purpose: To compare the anesthetic effectiveness of topical proparacaine drops, subconjunctival lidocaine, and 2% lidocaine gel. Methods: Ninety-two patients undergoing intravitreal injections were randomized to 1 of 3 groups: proparacaine 0.5% drops (Group Drops), proparacaine 0.5% drops plus subconjunctival lidocaine (Group SC), or 2% lidocaine gel (Group Gel). Patients were asked to score their pain experience using a visual analog scale of 0 to 10 immediately following the injections and 10 min, 1 h, 6 h, and 24 h after the injections. Patients also graded the overall injection experience as Excellent, Very Good, Fair, Poor, or Awful. The physician evaluated the patients’ eye movement during intravitreal injection on 3 levels: (0) none or minimal, (1) not compromising the injection, and (2) compromising the injection. Results: The patients in Group Drops had the worst mean pain scores during the injection and 10 min after, with the highest occurrence of movements compromising the procedure (Grade 2; 38.7%). The patients in Group SC had a higher percentage of good experiences (37.9%) but a higher incidence of chemosis (16.7%). The patients in Group Gel had similar overall pain scores to Group Drops patients but a higher incidence of keratitis (19.4%). There was no statistically significant correlation between the use of aspirin or anticoagulants and the occurrence of hyperemia or hyposphagma. Conclusion: Subconjunctival lidocaine was most effective in preventing pain and eye movements during intravitreal injections. Although 2% lidocaine gel produced a good overall experience for the patients, the incidence of keratitis was very high (19.4%). Therefore, we do not recommend 2% lidocaine gel as the first anesthetic choice for intravitreal injections. There is no evidence to suspend the use of aspirin or other anticoagulants drugs prior to intravitreal injections. .

Objetivo: Comparar a eficácia anestésica entre proparacaína tópica, lidocaína subconjuntival e lidocaína gel a 2%. Métodos: Noventa e dois pacientes em tratamento com injeções intravítreas foram randomizados para um de três grupos: proparacaína 0,5% gotas (Grupo gotas), proparacaína 0,5% gotas seguida de lidocaína subconjuntival (Grupo SC), ou lidocaína gel a 2%. (Grupo Gel). Os pacientes foram orientados a graduar a sua experiência de dor por uma escala visual analógica, numa escala de 0 a 10, imediatamente após as injeções, bem como 10 minutos, 1 hora, 6 horas e 24 horas após. Os pacientes também classificaram a experiência global de injeção como excelente, muito boa, regular, ruim ou horrível. O médico avaliou o movimento do olho do paciente durante a injeção intravítrea em três níveis: nenhuma ou mínima (0), não comprometendo a injeção (1), comprometendo a injeção (2). Resultados: Os pacientes do grupo gotas apresentaram uma graduação média de dor pior durante a injeção e 10 minutos após, com maior ocorrência de movimentos comprometendo a injeção (grau 2) (38,7%). Os pacientes do grupo SC, apresentaram maior percentual de boa experiência durante o procedimento (37,9%) e maior ocorrência de quemose (16,7%). Os pacientes do grupo Gel apresentaram escore de dor geral semelhante ao grupo Gotas e maior incidência de ceratite (19,4%). Não houve correlação estatisticamente significativa com o uso de aspirina ou anticoagulantes e a ocorrência de hiperemia ou hiposfagma. Conclusão: Lidocaína subconjuntival foi mais eficaz na prevenção da dor durante injeção intravítrea com movimentação ocular mínima. Embora os pacientes do grupo lidocaína gel a 2% tenham apresentado uma boa experiência, consideramos a incidência ceratite muito elevada (19,4%) e não recomendamos lidocaína gel a 2% como a primeira escolha como anestésico para injeções intravítreas. Não há evidência para a suspensão do uso de aspirina ou drogas anti-coagulantes em pacientes ...