[Comparison between the pain induced by phacoemulsification with topical anesthesia and by peribulbar anesthesia without sedation]. / Comparação entre a dor provocada pela facoemulsificação com anestesia tópica e a pela infiltração peribulbar sem sedação.

PURPOSE: To compare pain sensation induced by phacoemulsification with topical anesthesia with that by peribulbar anesthesia, without sedation. METHODS: Using a 10-level visual pain analogue scale, the pain induced by phacoemulsification with topical anesthesia (2% tetracaine drops) was measured in 20 patients. The same scale was used to measure the pain induced by peribulbar anesthesia (2% lidocaine and 0.5% bupivacaine) in 21 patients. The same surgeon performed peribulbar infiltrations and surgeries. The phacoemulsifications were done using clear corneal approach followed by in-the-bag intraocular lens implantation. Pain comparison between the two groups was performed by the non-parametrical U Mann-Whitney test. RESULTS: The distribution of the pain scores of the patients who underwent cataract extraction with topical anesthesia ranged from 0 to 5 (median value = 2). The scores of the patients who underwent peribulbar infiltration ranged from 0 to 7 (median value = 3). The mean rank of the group of patients who had surgery with topical anesthesia (15.78) was significantly different from the mean rank of the patients who received peribulbar anesthesia (25.98) (p = 0.0057). CONCLUSION: Without sedation, the pain induced by phacoemulsification with topical anesthesia was milder than the pain induced by peribulbar infiltration.

Pain induced by phacoemulsification without sedation using topical or peribulbar anesthesia.

PURPOSE: To evaluate patient-reported pain induced by phacoemulsification without sedation using topical or peribulbar anesthesia. SETTING: Department of Ophthalmology, School of Medicine of Ribeirão Preto, São Paulo, Brazil. METHODS: This study assessed patient-perceived pain during phacoemulsification cataract surgery with peribulbar anesthesia (lidocaine 2%-bupivacaine 0.5% mixture) or with topical anesthesia (tetracaine drops); no patient received sedation. The same surgeon performed all surgeries using a clear corneal approach and in-the-bag intraocular lens implantation. Approximately 15 minutes after surgery, patients in the topical anesthesia group (n = 20) were asked to rate their pain during the procedure and patients in the peribulbar anesthesia group (n = 21), during infiltration of the anesthetic solution. Patients graded their pain using a 0- to 10-point visual analog scale (0 = no pain; 10 = unbearable pain). The results in the 2 groups were compared using the nonparametric Mann-Whitney U test. RESULTS: The median pain score in the topical anesthesia group was 2 (range 0 to 5) and in the peribulbar anesthesia group, 3 (range 0 to 7). The mean rank in the topical anesthesia group (15.78) was significantly lower than the mean rank in the peribulbar anesthesia group (25.98) (P = .0057, Mann-Whitney U test). CONCLUSION: In patients having phacoemulsification without sedation, those receiving peribulbar anesthesia reported more pain than those receiving topical anesthesia during anesthetic solution infiltration and during the procedure, respectively.

Comparação entre a dor provocada pela facoemulsificação com anestesia tópica e a pela infiltração peribulbar sem sedação / Comparison between the pain induced by phacoemulsification with topical anesthesia and by peribulbar anesthesia without sedation

OBJETIVO: Comparar a sensação de dor produzida pela realização de facoemulsificação com anestesia tópica com a induzida pela infiltração peribulbar de solução anestésica. MÉTODOS: Usando-se uma escala visual análoga de dor de 10 níveis, mediu-se em 20 pacientes, a dor provocada pela realização de facoemulsificação com anestesia tópica (tetracaína 2 por cento). A mesma escala foi usada para medir em 21 outros pacientes, a dor provocada pela infiltração peribulbar de solução anestésica (lidocaína a 2 por cento e bupivacaína 0,5 por cento). As infiltrações peribulbares e cirurgias foram feitas pelo mesmo cirurgião. As facoemulsificações foram realizadas com acesso "clear cornea" e implante de lente intra-ocular dentro do saco capsular. Não foi administrada qualquer medicação venosa ou via oral. Os valores de dor nos dois grupos estudados foram comparados pelo teste, não paramétrico, de Mann-Whitney U. RESULTADOS: A distribuição dos valores de dor da facectomia com anestesia tópica variou de 0 a 5, com mediana igual a 2. Com a infiltração peribulbar a distribuição obtida foi mais ampla, de 0 a 7, com mediana igual a 3. O teste de Mann-Whitney U, revelou que o "rank" médio do grupo da cirurgia com anestesia tópica (15,78) foi significantemente diferente do obtido com a infiltração peribulbar (25,98) (p=0,0056). CONCLUSAO: Quando não se emprega sedação, a sensação de dor induzida pela realização da cirurgia da facoemulsificação com anestesia tópica é menor do que a causada pela anestesia peribulbar.