A Systematic Review and Meta-analysis of Methods for Reducing Local Anesthetic Injection Pain Among Patients Undergoing Periocular Surgery

Abstract

Purpose: Various factors help minimize pain during the injection of local anesthetic. The majority of current evidence involves nonspecific injection sites. The objective of this review was to provide a comprehensive summary of all existing evidence for methods used to reduce injection pain specifically in the context of periocular procedures. Methods: A literature search of the MEDLINE, EMBASE, and Scopus databases was conducted to identify all relevant experimental and observational studies from 1946 to 2018. Studies were included of patients undergoing periocular surgery under subcutaneous local anesthesia whereby outcomes were reported following a specific intervention intended to help reduce pain. Risk of bias was assessed using recognized tools. A subgroup meta-analysis was performed to indirectly compare pooled intervention-versus-control differences for various pain reduction interventions. Results: Following the review of 2089 search results, 23 articles representing 1135 patients were included. The methods assessed in the studies included choice of anesthetic agent, buffering, warming, dilution, needle type, administration of an inhalational anesthetic, application of topical anesthetics, iontophoresis, skin cooling with ice, tactile distraction with vibration, and decreasing the rate of injection. Conclusions: Methods demonstrating best efficacy included solution modification (buffering, dilution, warming), skin cooling with ice, vibration, transconjunctival topical anesthetic before injection, and decreased rate of injection. Further study is warranted for modification of equipment factors, topical anesthetics, and strategies to reduce pain because of anesthetic infiltration.

Insulin syringe for anaesthetic injection in ptosis surgery: A randomised controlled clinical study

“…Recently, a systematic review including 23 randomised controlled trials investigated local anaesthesia in periocular procedures. 22 Only one of these studies examined the needle type as an equipment factor. 21 Forty four patients (mean age=31) undergoing blepharoplasty used a blunt 27-gauge needle, which has the same thickness as a conventional sharp needle, to compare pain, bruising, and hematoma formation.…”

“…[15][16][17][18][19][20][21] Furthermore, various studies have reported factors that help minimise pain during local anaesthesia, which include the choice of the anaesthetic agent, dilution, buffering, and skin cooling. 22 Anaesthetic injections can also lead to tissue distortion and bleeding, which further distort the anatomical structures, making it more di cult to perform surgery accurately; thus, care should be taken to limit these. 3 4 21 Various studies have been conducted to nd factors that reduce the pain of anaesthetic injections.…”

“…3 4 21 Various studies have been conducted to nd factors that reduce the pain of anaesthetic injections. 21 22 However, only one study has examined the difference in pain caused by the type of needle. 21 22 Yu et al reported that using 27-gauge blunt needles reduces pain and hematoma occurrence compared to using a 27-gauge conventional sharp needle during anaesthesia for upper blepharoplasty.…”

“…21 22 However, only one study has examined the difference in pain caused by the type of needle. 21 22 Yu et al reported that using 27-gauge blunt needles reduces pain and hematoma occurrence compared to using a 27-gauge conventional sharp needle during anaesthesia for upper blepharoplasty. 21 This type of blunt needle has been introduced in some limited areas, such as interventional radiology, to avoid inadvertent penetration of vital structures, but it is not yet widely used in eyelid surgery.…”

Bacteriostatic preserved saline for pain-free periocular injections: review

“…PS has been explored as an alternative local anaesthetic option for a variety of indications. These include pain associated with: venipuncture [ 13 ], insertion of intravenous catheters [ 14 – 17 ], subcutaneous drug administration [ 18 ], intravenous drug administration [ 10 ], intra-articular injections [ 19 ], cervical dilatation for suction and curettage [ 20 ], periocular surgery [ 21 – 24 ] and periocular botulinum toxin A injections [ 25 – 28 ].…”