Randomized clinical trial of two anesthetic techniques for intravitreal injections: 4% liquid lidocaine on cotton swabs versus 3.5% lidocaine gel

Gregori, Ninel Z.; Weiss, Matthew J.; Goldhardt, Raquel; Schiffman, Joyce C.; Vega, Edgardo; Mattis, Cherrie Ann; Shi, Wei; Kelley, Linda M.; Hernández, V. Arteaga; Feuer, William J.

doi:10.1517/17425247.2012.685155

Cited by 11 publications

(15 citation statements)

References 11 publications

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“…To our knowledge, there are no data in the literature regarding efficacy of higher concentrations of lidocaine than 3.5% lidocaine gel or 4% lidocaine liquid [3,12] for IVTs.…”

Section: Introductionmentioning

confidence: 98%

Safety and efficacy of various concentrations of topical lidocaine gel for intravitreal injection

Shiroma

Nunes

Farah

et al. 2014

Expert Opinion on Drug Safety

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“…To our knowledge, there are no data in the literature regarding efficacy of higher concentrations of lidocaine than 3.5% lidocaine gel or 4% lidocaine liquid [3,12] for IVTs.…”

Section: Introductionmentioning

confidence: 98%

Safety and efficacy of various concentrations of topical lidocaine gel for intravitreal injection

Shiroma

Nunes

Farah

et al. 2014

Expert Opinion on Drug Safety

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“…This was done as part of a randomized clinical trial comparing pain control efficacy of the two anesthetic techniques, which has been published elsewhere. 13 Secondary outcome measure was post-injection IOP change with and without pressure on the eye. These data are presented here.…”

Section: Introductionmentioning

confidence: 99%

Ocular Decompression With Cotton Swabs Lowers Intraocular Pressure Elevation After Intravitreal Injection

Gregori

Weiss

Goldhardt

et al. 2014

Journal of Glaucoma

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Objective To determine the effect of pre-injection ocular decompression by cotton swabs on the immediate rise in intraocular pressure (IOP) after intravitreal injections. Methods Forty-eight patients receiving 0.05-ml ranibizumab injections in a retina clinic were randomized to two anesthetic methods in each eye on the same day (if bilateral disease) or on consecutive visits (if unilateral disease). One method utilized cotton swabs soaked in 4% lidocaine applied to the globe with moderate pressure and the other 3.5% lidocaine gel applied without pressure. IOPs were recorded at baseline (before injection) and at 0, 5, 10, and 15 minutes after the injection until the IOP was ≤30 mmHg. The IOP elevations from baseline were compared after the two anesthetic methods. Results The pre-injection mean IOP (SD, mmHg) was 15.5 (3.3) before the cotton swabs and 15.9 (3.0) before the gel (p=0.28). Mean IOP (SD, mmHg) change immediately after injection was 25.7 (9.2) after the cotton swabs and 30.9 (9.9) after the gel (P=0.001). Thirty-five percent of gel eyes had IOP ≥50 mmHg compared to only 10% of cotton swab eyes immediately after the injection (P<0.001). Conclusion Decompressing the eye with cotton swabs during anesthetic preparation prior to an intravitreal injection produces a significantly lower IOP spike after the injection.

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“…Although no consensus has been reached, topical anesthesia by either drops or gel has been repeatedly shown to be very effective in pain control during intravitreal injections. [26][27][28][30][31][32][33] Therefore, it has been generally agreed that topical anesthesia is most comfortable and cost effective, 27,32,34 and this is currently the most commonly used protocol before intravitreal injections. Pain associated with intravitreal injections is generally mild, and mean VAS scores reported in previous studies during these injections varied from 12 to 35.…”

Section: Discussionmentioning

confidence: 99%

“…Pain associated with intravitreal injections is generally mild, and mean VAS scores reported in previous studies during these injections varied from 12 to 35. 17,30,31,[35][36][37][38] A previous study performed in our department regarding pain sensation associated with intravitreal injections of bevacizumab includes the largest series (218 patients) published to date. 17 No correlation was found between pain and age, sex, indication for injection, number of previous injections, presence of DM, and lens status.…”

Section: Discussionmentioning

confidence: 99%

“…First, the similarity in pain may reflect the use of the same topical anesthesia protocol in both groups. Topical anesthesia with lignocaine gel is very effective for intravitreal injections, [30][31][32][33][34] and it may have blunted the increased pain that could have resulted from the larger Ozurdex injection. Second, Ozurdex was injected through a customized applicator, whereas bevacizumab was injected from a simple syringe.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of pain during intravitreal Ozurdex injections vs intravitreal bevacizumab injections

Moisseiev

Regenbogen

Rabinovitch

et al. 2014

Eye

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Purpose The purpose was to evaluate the pain associated with intravitreal Ozurdex injections, and to compare it with that associated with intravitreal bevacizumab injections. Methods The study included 57 eyes of 57 patients who received an intravitreal Ozurdex injection at our institution. Pain was measured by the visual analog scale (VAS). Additional parameters recorded included age, sex, indication for the injection, number of previous Ozurdex injections in the study eye, presence of diabetes mellitus, and lens status. Data were compared with a 2 : 1 sexand age-matched control group of 114 patients who received intravitreal bevacizumab injections. Results Indications for injection included diabetic macular edema (40.4%) and macular edema secondary to central and branch retinal vein occlusion (28% and 31.6%, respectively). Pain scores on the VAS ranged from 0 to 90, with a mean of 20.8±20.3. There was no significant difference in pain between Ozurdex and bevacizumab injections. Pseudophakia was correlated with increased pain in Ozurdex injections. Conclusions This is the first series evaluating the pain associated with intravitreal Ozurdex injections. Despite a larger needle gauge and tunneled injection technique, intravitreal injection of Ozurdex is not associated with increased pain compared with bevacizumab. This finding may be a potential advantage for Ozurdex, and may serve to improve patient compliance with future long-term treatment protocols.

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Randomized clinical trial of two anesthetic techniques for intravitreal injections: 4% liquid lidocaine on cotton swabs versus 3.5% lidocaine gel

Abstract: Both techniques are equally effective and yield mild discomfort scores during the procedure and the next day. The gel method results in significantly less ocular surface irritation.

Cited by 11 publications

References 11 publications

Safety and efficacy of various concentrations of topical lidocaine gel for intravitreal injection

Safety and efficacy of various concentrations of topical lidocaine gel for intravitreal injection

Ocular Decompression With Cotton Swabs Lowers Intraocular Pressure Elevation After Intravitreal Injection

Evaluation of pain during intravitreal Ozurdex injections vs intravitreal bevacizumab injections

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