Differences in pain experience and cooperation between consecutive surgeries in patients undergoing phacoemulsification

Abstract

The purpose of this study is to compare pain experience and cooperation between consecutive surgeries in patients undergoing phacoemulsification in both eyes, using sub-Tenon's local anesthesia without sedation. In this study, 268 patients with bilateral senile cataracts were recruited. All operations were performed without sedation, using a clear corneal phacoemulsification technique and sub-Tenon's local anesthesia, by one of four surgeons. The first surgery was performed on the eye with the higher grade cataract. The other eye was operated on within 3 months by the same surgeon (mean interval 1.9 ± 1.1 months). All patients were asked to grade their pain experience during induction and maintenance of anesthesia and also during the phacoemulsification surgery, using a visual analogue scale (VAS) from 0 (no pain) to 10 (unbearable pain) administered after the surgery. The cooperation of the patient was graded from 0 (no event) to 3 (markedeye and head movement and lid squeezing) by the attending surgeon. The VAS scores and cooperation scores of the patients were the outcome measurements. The mean pain score was 2.11 ± 0.79 in the first eye and 3.33 ± 0.80 in the second eye during the administration of sub-Tenon's anesthesia, and 1.50 ± 0.60 in the first eye and 2.10 ± 0.57 in the second eye during the phacoemulsification surgery. The patient cooperation score was 1.60 ± 0.75 in the first surgery and 2.08 ± 0.72 in the second surgery. The differences between the first and second surgeries were statistically significant for all outcome measures (p < 0.01). Patients who previously underwent phaco surgery in one eye experienced more pain and showed worse cooperation during the phaco surgery in the second eye, especially if there was a short time between the surgeries, viz., less than 3 months. Therefore, if the surgeon has difficulty in the first operation gaining the patient's cooperation, the surgeon must be careful: if contralateral eye surgery is required, the addition of sedation/analgesia should be considered or the surgery postponed for a while to abolish the influence of recent memory on the patient's subsequent pain experience.

Hypnosis intervention for the management of pain perception during cataract surgery

“…In conventional cataract surgery, a skilled doctor can perform a successful phacoemulsification surgery in approximately 10 minutes, and topical anesthesia is thus often used to save time; however, topical anesthesia is not always completely effective for relieving pain and anxiety in phacoemulsification surgery. Most recent studies have focused on determining whether the pain experienced during the second-eye surgery is greater than or equal to that experienced during the first-eye surgery, 16 – 19 but few researchers have focused on reducing patient pain during the cataract surgery under topical anesthesia. In fact, if the patient experienced pain during the first-eye surgery, particularly obvious pain, he/she will inevitably experience pain and anxiety during the second-eye surgery if only local anesthesia is used without any auxiliary sedative measures.…”

A prospective observational cohort study to evaluate patients’ experience during sequential cataract surgery under monitored anesthesia care and topical anesthesia

“…Recently, consecutive phacoemulsification cataract surgeries have been increasing worldwide. [ 3 ] Pain is the most common symptom assessed when considering patients’ satisfaction during and after cataract surgery, being topical anesthesia combined with MAC widely accepted for this type of procedure. [ 1 , 11 ] However, other determinant variables such as anxiety, awareness, and general comfort are frequently overlooked.…”

“…[ 3 , 13 , 14 ] These variations have been associated with the patients’ ability to recall their intraoperative overall experience and the level of sedation. [ 1 – 3 , 11 ] Moreover, the level of pain experienced may have a significant impact on patients’ cooperation during surgery. [ 3 , 4 ]…”

“…[ 1 – 3 , 11 ] Moreover, the level of pain experienced may have a significant impact on patients’ cooperation during surgery. [ 3 , 4 ]…”

“…Even though some reports showed more discomfort during surgery 2, the independent evaluation of this variable could be challenging. [ 1 , 3 , 11 ] Level of comfort, awareness, and patients’ cooperation with the surgical procedure are significantly affected by intraoperative pain. [ 3 ] Although higher comfort levels were experienced during surgery 1 in our patient setting, these results were not statistically significant and were not correlated with significant changes in pain levels between procedures.…”