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Anesthetic Effectiveness of Topical Levobupivacaine 0.75% Versus Topical Proparacaine 0.5% For Intravitreal Injections
Anesthetic Effectiveness of Topical Levobupivacaine 0.75% Versus Topical Proparacaine 0.5% For Intravitreal Injections
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ORIGINAL ARTICLE
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A B S T R A C T
Background and Purpose: Today no method of topical anesthesia for intravitreal
injection administration has been proven to make the patient comfortable yet.
We compared the efficacy of topical levobupivacaine 0.75% and proparacaine
0.5% in patients undergoing intravitreal injections. Materials and Methods: A
prospective, randomized study comparing two agents for topical anesthesia in
intravitreal injections. Ninety-six consecutive patients were enrolled into two groups
to receive either topical levobupivacaine 0.75% (n=48) or proparacaine 0.5%
(n=48). Patients were asked to score their pain using a visual analog scale (VAS)
immediately following the injection. The average of these scores was used as the
primary outcome. The surgeon performing the procedure scored his perception of the
patients pain using the Wong-Baker FACES scale. Results: Mean VAS pain scores
for two groups were found to be 44.77 16.42 and 34.18 14.83, respectively.
Mean VAS pain score in the proparacaine group was significantly lower than that
in the levobupivacaine group (P= 0.003). Mean Wong-Baker FACES scores for
the two groups were 1.08 0.49 and 1.10 0.30, respectively. There was
no statistically significant difference between levobupivacaine and proparacaine
groups (P=0.824). Conclusions: Topical proparacaine 0.5% was more effective in
preventing pain during intravitreal injections.
Department of Ophthalmology,
1
Anesthesiology, School of
Medicine, Krkkale University,
Krkkale, Turkey
INTRODUCTION
Intravitreal injection is a preferred route of delivering
various therapeutic agents to the posterior segment
of the eye. However, it may be associated with
significant patient anxiety and discomfort and carries
risk of complications such as endophthalmitis,
vitreous hemorrhage, retinal detachment, and traumatic
cataract.[1,2] As the number of intravitreal pharmacologic
agents with sustained delivery systems increase, many
patients will require ongoing treatments with monthly
or near-monthly injections. Therefore, an ocular
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DOI:
10.4103/1658-354X.130713
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Age (years)
mean SD
Gender (%)
Female
Male
Eye (%)
Right
Left
Group 1 (n=48)
Levobupivacaine
63.97 10.23
Group 3 (n=48)
Proparacaine
65.02 6.28
58.33
41.66
35.41
64.59
47.91
53.09
60.41
39.59
Group 1 (n=48)
Levobupivacaine
44.77 16.42
Group 2 (n=48)
Lidocaine
51.58 20.21
P value
1.08 0.49
1.27 0.53
0.824
0.003
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