Patient Pain Evaluation of Varying Anesthesia Methods and Needle Gauges for Intravitreal Injections

摘要

Purpose: : To determine which method of anesthesia and needle gauge provides the most effective pain control with intravitreal injection (IVT). Methods: : This was a retrospective study in which consecutive patients who had been treated with one of six anesthesia protocols prior to IVT were asked to evaluate pain levels for the anesthesia process (AP), the intravitreal injection (IP), and the post-operative period (PP) using the visual analog pain scale. All patients were pretreated with one drop of proparacaine immediately followed by one drop of tetracaine 0.5%. The protocols were: 1. pledget soaked in 4% lidocaine and applied for 30 s. X 3 followed by IVT w/ a 30G needle. 2. Same as 1 w/32 G needle. 3. Subconjunctival injection (SC) of lidocaine 2% w/out epinephrine followed by IVT w/30G needle, 4. Same as 3 w/ 32 G needle. 5. AK-TEN applied followed by IVT w/ 30G needle. 6. Same as 5 w/ 32G needle. Groups 1-6 had 26, 22, 22, 25, 21, and 21 patients respectively. Each group was statistically compared to all other groups in each category. Groups 1,3, and 5 were combined and groups 2,4,and 6 were combined and compared to each other in the categories of IP and PP. Groups 1 and 2 were combined, as were groups 3 and 4, and groups 5 and 6. Those three resulting groups were compared with each other. Results: : The mean IP for groups 2,4,6 was 1.4 +/- 2.2 for groups 1,3,5 was .73 +/-1.5; p = .06. The PP score mean for groups 2,4,6 was 1.0 +/-1.6 for 1,3,5 was .62 +/-1.3; p =.09. There was no significant difference between the pain scores for any of the individual groups for AP, IP, and PP or for the sum of AP, IP and PP. The only significant difference was between Group 3,4 mean IP was .55 +/-1.6, and group 5,6 mean IP was 1.5 +/-2.3, p =.03. Conclusions: : Subconjunctival injection was more comfortable than AK-TEN for IP. There was not a statistical difference in IP between 30 and 32G needles, but there was a trend toward less discomfort with the 30G needle which may be due to bending of the smaller gauge needle causing a longer insertion time. This would suggest that use of less expensive and equally comfortable 30G needles would be better than 32G needles.