Randomized Trial of Anesthetic Methods for Intravitreal Injections

Abstract

Topical anesthesia is an effective method for limiting pain associated with intravitreal injections.

Topical anesthesia for intravitreal injection

“…A similar study conducted by Blaha et al prospectively compared the effectiveness of 0.5% proparacaine, 0.5% tetracaine, 4% lidocaine pledget, and subconjunctival injection of 2% lidocaine for intravitreal injection in 24 patients. There was no statistical difference in pain control among the different anesthetic options although subconjunctival lidocaine injection had the most side effects (subconjunctival hemorrhage and the possibility of intravitreal injection of lidocaine) [9]. These results were consistent with the findings of similar study performed by Kozak in 2005 in which it was showed that lidocaine 2% gel provided satisfactory pain control and produced less chemosis and hemorrhage than subconjunctival anesthesia [10].…”

Topical Anesthesia with Ropivacaine and Proparacaine for Intravitreal Injection Procedures

“…In agreement with this conclusion, Yau et al, showed that there was no difference in patient pain experience between the 3 (tetracaine, lidocaine and cocaine) anesthetic options tested [7]. Similarly, Blaha et al, compared lidocaine pledget, topical proparacaine, subconjunctival lidocaine and topical tetracaine without obtaining any significant difference in patient pain experience [8].…”

Evaluation of pain during intravitreal Ozurdex injections vs intravitreal bevacizumab injections

“…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.…”

“…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.…”