Patient pain during intravitreal injections under topical anesthesia: a systematic review.

Autor: Shiroma HF; Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, Rua Pastor William Richard Schisler 900/apto 1011, Florianópolis, SC 88034-100 Brazil., Takaschima AKK; Florianopolis Hospital, Florianópolis, Brazil., Farah ME; Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, Rua Pastor William Richard Schisler 900/apto 1011, Florianópolis, SC 88034-100 Brazil., Höfling-Lima AL; Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, Rua Pastor William Richard Schisler 900/apto 1011, Florianópolis, SC 88034-100 Brazil., de Luca Canto G; Brazilian Centre for Evidence-based Research, Health Sciences Centre, Federal University of Santa Catarina, Florianopolis, Brazil., Benedetti RH; Unisul-Universidade do Sul de Santa Catarina, Tubarão, Brazil., Rodrigues EB; Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, Rua Pastor William Richard Schisler 900/apto 1011, Florianópolis, SC 88034-100 Brazil.
Jazyk: angličtina
Zdroj: International journal of retina and vitreous [Int J Retina Vitreous] 2017 Jul 03; Vol. 3, pp. 23. Date of Electronic Publication: 2017 Jul 03 (Print Publication: 2017).
DOI: 10.1186/s40942-017-0076-9
Abstrakt: Background: Intravitreal injection (IVI) is a very common vitreoretinal procedure, and multiple injections are often required per patient. This systematic review was conducted to evaluate the effectiveness of various local anesthetic techniques in reducing pain during injection.
Methods: A systematic review was conducted based on searches of Cochrane, LILACS, PubMed, Scopus, Web of Science, and the gray literature (Google Scholar). The end search date was February 19, 2016, across all databases. We classified pain by converting visual analog scale (VAS) scores (0-100 mm) into Jensen's classification levels: 0-4, no pain; 5-44, mild pain; 45-74, moderate pain; and 75-100, severe pain. An intervention was considered clinically significant when pain score change was >12 mm on a 100-mm scale.
Results: Eight studies out of 23 met the eligibility criteria. The total number of patients was 847. Most studies (5/8 [62.5%]) were at unclear risk of bias because of unclear randomization, thus providing only moderate evidence to this review. The anesthetic techniques included eye drops with proparacaine, tetracaine or cocaine, a lidocaine pledget or gel, and subconjunctival injection of 2% lidocaine or 0.75% levobupivacaine. No study comprised all of the techniques. Pain was mild (VAS scores, 5-44 mm) regardless of anesthetic technique. A clinically significant intervention (pain score change >12 mm) was found for only one study comparing proparacaine drops, lidocaine gel, and subconjunctival lidocaine; in that study, a subconjunctival injection of 2% lidocaine provided the greatest pain reduction. A meta-analysis was not possible due to study heterogeneity.
Conclusions: Patient pain during IVI under topical anesthesia is mild regardless of anesthetic technique. A subconjunctival injection of 2% lidocaine could be an option for highly sensitive patients. However, with moderate level of evidence, no single anesthetic technique could be defined as the best option for IVI.
Databáze: MEDLINE
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