Alleviating Pain in Oculoplastic Procedures by Reducing the Rate of Injection of Local Anaesthetic

Abstract

Purpose :To investigate whether the rate of infiltration of local anaesthetic influences the pain or efficacy of local anaesthesia in oculoplastic surgery.Methods :A prospective observational study on consecutive patients undergoing a variety of oculoplastic procedures under local anaesthesia. An observer recorded the rate of injection of local anaesthetic during each procedure. The same mixture of local anaesthetic and the same needle gauge was used in all cases. Patients were asked to rate the pain of both the injection and the surgery using a visual analog scale (VAS).Results :77 consecutive patients were observed, 39/77 (50.6%) patients were female and the average age was 63.5 years (range 31-94). A statistically significant correlation was found between the rate of injection and the VAS score from the injection (p<0.0001, r=0.42). There was no significant correlation between the injection rate and the VAS score from the procedure itself (p=0.25, r=0.13). Additionally, a significant correlation was found between the injection VAS score and the procedure VAS score (p=0.0002, r=0.42).Conclusion :The slower the rate of injection of local anaesthetic, the less pain was reported by the patient from the injection itself. Indeed the perception of pain from the surgery overall was significantly related to the pain felt during the injection, highlighting the importance of minimising pain during the injection of the local anaesthetic. We conclude that slowing the rate of injection is an effective way of alleviating pain from administration of the anaesthetic.

Comparison of pain relief in soft tissue tumor excision: anesthetic injection using an automatic digital injector versus conventional injection

“…Pain is a complex and subjective sensation that is influenced by various factors as patients can experience varying degrees and forms of pain [ 1 , 3 ]. There are various techniques that can help alleviate the discomfort caused by injection pain, including the utilization of multiple forms of sensory noise, administering the needle perpendicularly, opting for a smaller needle, or gradually decreasing the injection rate [ 4 , 5 , 10 ]. However, previous attempts have focused on changing the technique and we have tried to change the tools used for anesthesia.…”

“…When anesthesia is first injected, a high pressure needs to be quickly injected to overcome tissue resistance, causing severe pain to patients. If the anesthesia is injected slowly, the tissue will expand slowly, reducing the pain [5], but the total time required for anesthesia may increase, potentially leading to an increase in pain perceived by the patient. NPRS is an effective and valid tool for measuring pain in many areas [11], including excision surgery.…”

“…Pain during injection of local anesthetic is caused due to the skin piercing of the needle or the pressure of the solution stretching the skin [ 4 ]. This injection pain could be reduced by several methods such as using more than one type of sensory noise, inserting the needle perpendicularly, using smaller needle, or slowing the rate of injection [ 4 , 5 ].…”

Local Anesthesia in Interventional Radiology

“…Evidence has shown that slower injection speed is associated with less patient discomfort. 55 Once the tract is fully anesthetized, the access needle can be advanced through the “cylinder of local anesthetic” into the target of choice ( Fig. 1 ).…”

Local anesthesia and anxiolytic techniques for oculoplastic surgery

“…It is widely recommended that anesthetic injections should be administered slowly in the eyelid to decrease discomfort 27. The slow administration of lidocaine may have a greater impact on decreasing perceived pain than buffered lidocaine 58.…”