Unpreserved lidocaine to control discomfort during cataract surgery using topical anesthesia

Gills, James P.; Cherchio, Myra; Raanan, Marsha G.

doi:10.1016/s0886-3350(97)80211-8

Cited by 135 publications

(80 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Because of the shortacting effect, intraoperative and/or postoperative pain, and dissatisfaction may be associated with the use of topical lidocaine. [13][14][15] Ropivacaine is a monoamide local anaesthetic (LA) agent with a long-acting effect and a great margin of safety. The cardiac and central nervous system toxicity is less than the others used in topical anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

Comparative clinical trial of topical anaesthetic agents for cataract surgery with phacoemulsification: lidocaine 2% drops, levobupivacaine 0.75% drops, and ropivacaine 1% drops

Borazan

Karalezlı

Akova

et al. 2007

Eye

View full text Add to dashboard Cite

Purpose To assess the safety and efficacy of topical lidocaine, levobupivacaine, and ropivacaine in cataract surgery with phacoemulsification. Methods One hundred and five patients scheduled for cataract surgery with topical anaesthesia were randomly allocated into 3 groups of 35 patients each to receive eye drops of lidocaine 2%, levobupivacaine 0.75%, or ropivacaine 1% every 5 min starting 30 min before surgery. Patients graded their pain using a 0-10-point verbal pain score (VPS) at different stages of the procedure. The levels of patient and surgeon satisfaction, the duration of surgery, complications, and the need for supplemental anaesthesia were recorded. Results There was no significant difference in duration of surgery and demographic variables among the groups. At the intraoperative period, end of surgery, and postoperative first hour the mean VPS in the lidocaine group was significantly higher than the others (Po0.01), but no significant difference was found between the levobupivacaine and ropivacaine groups. At incision and 24 h after surgery, it was not significantly different among the groups. Surgeon and patient satisfaction scores were significantly better in the levobupivacaine and ropivacaine groups than in the lidocaine group (Po0.01).Conclusions Topical anaesthesia with levobupivacaine and ropivacaine were safe, feasible and more effective than lidocaine in cataract surgery. Levobupivacaine and ropivacaine provided sufficient and long-lasting analgesia without the need of supplemental anaesthesia for each patient.

show abstract

Section: Introductionmentioning

confidence: 99%

Comparative clinical trial of topical anaesthetic agents for cataract surgery with phacoemulsification: lidocaine 2% drops, levobupivacaine 0.75% drops, and ropivacaine 1% drops

Borazan

Karalezlı

Akova

et al. 2007

Eye

View full text Add to dashboard Cite

show abstract

“…[7,9] However, safer and newer drugs are being investigated in ocular anesthesia to improve surgical techniques. In particular, ropivacaine may represent a safer alternative to lidocaine, thanks to its long-term efficacy and modest vasoconstrictive action, which is usually an advantageous side effect in anterior segment surgery.…”

Section: Resultsmentioning

confidence: 99%

“…[2][3][4] However, intraoperative discomfort and pain, particularly during phacoemulsification and intraocular lens implantation, have necessitated the association with subconjunctival, retrobulbar, or peribulbar anesthesia. [5,6] Gills et al [7] have reported encouraging results in reducing intraoperative discomfort during cataract surgery through the intracameral injection of 1% unpreserved lidocaine in the presence of topical anesthesia. The same authors have found in their studies that intraocular lidocaine does not damage corneal endothelium (cell count and corneal thickness).…”

Section: Short Communicationmentioning

confidence: 99%

Cataract Surgery Complications

et al. 2011

View full text Add to dashboard Cite

Background: Intraoperative lidocaine is widely used in controlling discomfort during cataract surgery. However, recent studies have confirmed the toxic effect of lidocaine on ganglion cells. Ropivacaine is an anesthetic recently introduced in clinical practice that couples a long anesthetic effect with a mild vasoconstrictive action. Objective: The aim of this study was an in vitro evaluation of the efficacy of ropivacaine in reducing the degenerative effects usually observed during lidocaine treatment. Methods: Ropivacaine and lidocaine toxicity has been evaluated in murine fibroblasts 3T6 by measuring percentage of cell death, cell growth inhibition, and DNA degradation. The choice of this cellular line is motivated by the presence of a complete apoptotic system that can be assimilated to the endothelium precursor cells. Results: We observed that lidocaine 0.25% decreases cell viability and causes DNA degradation in murine fibroblasts 3T6, whereas ropivacaine 0.5% does not cause any cellular or molecular degenerative effect. Conclusions: Our in vitro studies confirm that ropivacaine is less toxic than lidocaine to these cells. Therefore, in vivo studies in the anterior chamber could be useful to evaluate the effects of ropivacaine versus lidocaine in intracameral anesthesia in cataract surgery.

show abstract

“…The use of lidocaine gel as a topical anes thetic in phacoemulsification is thought to hydrate the cornea thus improving visualization by the surgeon during surgery and to reduce the need for the postoperative administration of a balanced salt solution (BSS) (19) . Intracameral addition of lidocaine is performed quite often (20)(21)(22)(23)(24) ; because in topical approaches only the trigeminal nerve ends in the cornea and conjunctiva are anesthetized, whereby complementary anesthesia by means of intracameral unpreserved lidocaine is nee- ded to avoid the irritation of the ciliary nerves due to occasional manipulation of the iris. Current evidence shows that intracameral lidocaine as a supplement in topical anesthesia induces significant reduction in pain perception during surgery when compared with topical anesthesia alone.…”

Section: Discussionmentioning

confidence: 99%

Assessing patient satisfaction with cataract surgery under topical anesthesia supplemented by intracameral lidocaine combined with sedation

Fernandes¹,

Souza²,

Vasconcelos

et al. 2013

Arq. Bras. Oftalmol.

View full text Add to dashboard Cite

INTRODUCTIONSignificant changes have been introduced to the techniques and instruments used for cataract surgery over the past 20 years. Such changes include phacoemulsification without corneal suture and the development of foldable intraocular lenses, which allow smaller and self-sealing incisions (1) . Additionally, a wide range of anesthetic techniques has been developed for cataract surgery during that period, including general, ophthalmic regional, and topical anesthesia (2) . ABSTRACTPurpose: Ocular akinesia, the use of anticoagulants, and patient collaboration are some of the factors that must be taken into consideration when choosing the appropriate anesthesia for phacoemulsification cataract surgery. The satisfaction of patients with the use of topical anesthesia and conscious sedation for this procedure has not been enough described in Brazil. Conscious sedation allows patient walk and answer a voice command. To assess the satisfaction, pain, and perioperative hemodynamic alterations of patients subjected to phacoemulsification under conscious sedation and topical anesthesia supplemented with intracameral lidocaine. Methods: Prospective cohort non-controlled study that included patients treated by the same surgical team over a 70-day period. Sedation was performed with midazolam at a total dose of 3 mg and topical anesthesia with 0.5% proxymetacaine chlorhydrate and 2% lidocaine gel combined with 2% lidocaine by intracameral route. The intraoperative vital parameters, scores based on the Iowa Satisfaction with Anesthesia Scale (ISAS), and the pain visual analog scale (VAS) were recorded at several time points after surgery. Results: A total of 106 patients were enroled in study (73.6% female), the mean age was 65.9 years. The surgical procedures lasted 11.2 minutes on average. The hemodynamic parameters did not exhibit significant changes at any of the investigated time points. The average ISAS score was 2.67 immediately after surgery and 2.99 eight hours after the surgery; this increase was statistically significant (p<0.0001). More than two-thirds (68.9%) of the participants (73 patients) did not report any pain in the transoperative period, and 98.1% of patients denied the occurrence of pain after surgery. Conclusions:Patients that received topical anesthesia supplemented by intracameral lidocaine combined with sedation for phacoemulsification cataract surgery reported adequate level of satisfaction with the anesthetic choice. Furthermore, the patients exhibited hemodynamic parameter stability and pain control.

show abstract

Unpreserved lidocaine to control discomfort during cataract surgery using topical anesthesia

Abstract: Intraoperative lidocaine is safe and effective in controlling intraoperative discomfort.

Cited by 135 publications

References 1 publication

Comparative clinical trial of topical anaesthetic agents for cataract surgery with phacoemulsification: lidocaine 2% drops, levobupivacaine 0.75% drops, and ropivacaine 1% drops

Comparative clinical trial of topical anaesthetic agents for cataract surgery with phacoemulsification: lidocaine 2% drops, levobupivacaine 0.75% drops, and ropivacaine 1% drops

Cataract Surgery Complications

Assessing patient satisfaction with cataract surgery under topical anesthesia supplemented by intracameral lidocaine combined with sedation

Contact Info

Product

Resources

About