Ophthalmology Unit, Palencia Hospital Complex (CAPA), Palencia, Spain.
Curr Eye Res. 2013 Feb;38(2):278-82. doi: 10.3109/02713683.2012.758290. Epub 2013 Jan 18.
To evaluate the efficacy of different anesthetics and topical anti-inflammatory treatment in patients undergoing intravitreal injections (IVI).
Prospective, randomized, double masked, comparative study. Patients undergoing 0.05 mL IVI were randomized to two different preoperative anesthetic regimes (regime A [0.5% tetracaine + naphazoline] versus regime B [5% lidocaine]) and two different post-injection topical protocols (protocol 1 [tobramycin qid] versus protocol 2 [tobramycin qid + diclofenac qid]). Patients were trained to score pain using a numerical rating pain scale from 0 (no pain) to 10 (excruciating pain) immediately after the injection, 30 min and 24 h later. Patients were instructed to take oral paracetamol (650-1000 mg, adjusted to the patient's weight) every six hours ad lib if necessary.
A total of 156 patients were enrolled; 86 patients were randomized to regime A and 70 to regime B; 78 patients were assigned to each of the post-injection topical protocols. The average pain score immediately after the IVI was 2.77 (SD 2.12) for the whole group (2.85, SD 2.23 with tetracaine and 2.67, SD 2.00 with lidocaine; p = 0.73, Mann-Whitney U-test). Twenty-four hours later, the average pain score was 1.84, SD 2.45 (topical diclofenac + tobramycin) versus 1.75, SD 1.83 (topical tobramycin; p = 0.46, Mann-Whitney U-test). Forty-seven patients (30%) required oral paracetamol (average 3.3 and range 1-5 tablets). Conjunctival hemorrhage 30 min after the injection was less frequent and severe in eyes treated with topical naphazoline (p = 0.055, Mann-Whitney U-test).
Topical tetracaine and lidocaine provide similar anesthesia before IVI. Topical diclofenac does not seem to reduce pain scores after IVI.
评估不同麻醉剂和局部抗炎治疗在接受玻璃体内注射（IVI）的患者中的疗效。
前瞻性、随机、双盲、对照研究。接受 0.05 mL IVI 的患者随机分为两种不同的术前麻醉方案（方案 A [0.5% 丁卡因+萘甲唑啉]与方案 B [5% 利多卡因]）和两种不同的注射后局部方案（方案 1 [妥布霉素 qid]与方案 2 [妥布霉素 qid+双氯芬酸钠 qid]）。患者在注射后立即、30 分钟和 24 小时后使用数字评分疼痛量表（0 表示无痛，10 表示剧痛）对疼痛进行评分。如果需要，患者被指示每六小时口服扑热息痛（650-1000mg，根据患者体重调整）。
共有 156 名患者入组；86 名患者被随机分配到方案 A，70 名患者被随机分配到方案 B；78 名患者被分配到每个注射后局部方案。整个组的平均疼痛评分在 IVI 后立即为 2.77（SD 2.12）（使用丁卡因时为 2.85，SD 2.23；使用利多卡因时为 2.67，SD 2.00；p=0.73，Mann-Whitney U 检验）。24 小时后，平均疼痛评分分别为 1.84，SD 2.45（局部双氯芬酸钠+妥布霉素）与 1.75，SD 1.83（局部妥布霉素；p=0.46，Mann-Whitney U 检验）。47 名患者（30%）需要口服扑热息痛（平均 3.3 片，范围 1-5 片）。注射后 30 分钟，使用局部萘甲唑啉治疗的眼睛结膜出血较少且较轻（p=0.055，Mann-Whitney U 检验）。
局部使用丁卡因和利多卡因在 IVI 前提供相似的麻醉效果。局部使用双氯芬酸钠似乎不能降低 IVI 后的疼痛评分。
