Replacement of Lidocaine Gel With Topical Proparacaine Anesthesia for Routine Intravitreal Injections

Abstract

Purpose: Lidocaine gel was suggested to be highly effective in providing anesthesia for intravitreal injections but adverse effects include a possibility of making sterilization of the conjunctiva difficult. Hence, we wished to determine the effect of using 0.5% proparacaine drops alone over the use of 3.5% lidocaine hydrochloride gel anesthesia during officebased intravitreal injections.Methodology: This was a case-control study in patients who came routinely to the clinic for antivascular endothelial growth factor injections. Eyes were treated with one of two anesthesia modalities. A total of 216 injections in 120 patients were reviewed. One group (N = 107) underwent anesthesia with 0.5% proparacaine drops, and the control group (N = 109) received 3.5% lidocaine gel. The pain perceived after injection was graded using the numerical rating scale, and score was immediately recorded by the "masked" injecting physician.Results: The mean pain score (±SD) for the proparacaine-only group versus gel group was 1.97 (±1.17) versus 1.76 (±0.92), P value = 0.3174. There was no statistical difference between the 2 groups.Conclusion: 3.5% lidocaine gel is not superior to 0.5% proparacaine drops as patients attained good pain control and excellent rates of overall satisfaction with proparacaine drops alone.

Effect of Anesthesia Duration on Intravitreal Injection Pain：A Double-blinded Randomized Comparative Study

“…Intravitreal injection pain reported in previous studies is generally mild. [1][2][3][4][5][6][7][8][9][10][11][12] In our trial, the mean VAS score of Group 4 was 1.97 6 1.04, slightly higher than the 1.74 6 1.71, 9 1.76 6 0.92, 3 1.78 6 1.44, 18 18 ). The highest pain score was 3.35 6 2.31 (Group 1), which is also lower than some of the abovementioned trials.…”

“…Previous trials comparing different topical anesthetic agents (proparacaine, tetracaine, lidocaine gel, or lidocaine-soaked cotton-tipped swabs) have found that proparacaine drops provide very effective and affordable anesthesia. [5][6][7][8][9] To our knowledge, this is the first clinical trial to evaluate the effects of different durations of topical anesthetic on IVI pain and to estimate the effects using two evaluation scales. The study demonstrated that different durations of topical anesthetics have different effects on pain relief for IVI and that 0.5% propara-caine hydrochloride drops were most effective in relieving IVI pain 11 to 20 minutes after topical administration.…”

“…To this end, a series of studies has been conducted concerning anesthetic techniques, anesthetic drugs, injection needle size, injection site, and preoperative administration of drugs. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] Topical anesthetics effectively relieve IVI pain. [3][4][5][6][7][8][9] However, their use does not remove patients' fear of IVIs, which affects their compliance with the treatment plan and thus management of their disease.…”

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16] Topical anesthetics effectively relieve IVI pain. [3][4][5][6][7][8][9] However, their use does not remove patients' fear of IVIs, which affects their compliance with the treatment plan and thus management of their disease. The conjunctiva and cornea can be anesthetized immediately after topical anesthetic is dropped onto the conjunctival sac.…”

“…To this end, a series of studies has been conducted concerning anesthetic techniques, anesthetic drugs, injection needle size, injection site, and preoperative administration of drugs. 3–16…”