Comparison of different topical anesthetic methods for intravitreal injections: a randomized crossover study

Area of Science:

• Ophthalmology
• Anesthesiology

Background:

• Intravitreal injections (IVI) are common ophthalmic procedures.
• Pain management during IVI is crucial for patient comfort and compliance.
• Topical proparacaine is frequently used, but its efficacy may be enhanced.

Purpose of the Study:

• To investigate the adjunctive effect of a proparacaine-soaked pledget to topical proparacaine drops for pain reduction during IVI.
• To assess patient-reported pain levels using a visual analog scale (VAS) and questionnaire.

Main Methods:

• A single-center, prospective, randomized, double-blinded crossover study involving 60 patients undergoing IVI.
• Patients received standard topical 0.5% proparacaine drops.
• Intervention groups received either a 0.5% proparacaine-soaked pledget or a normal saline-soaked pledget (placebo) in a crossover design.
• Pain was assessed using VAS and a questionnaire at immediate, 10-minute, and 20-minute intervals post-injection.

Main Results:

• No statistically significant difference in pain intensity was observed between the proparacaine pledget and placebo groups at any time point (p > 0.05).
• Pain scores were consistently lower in the placebo group immediately, 10 minutes, and 20 minutes post-injection, though not significantly.
• A subgroup analysis indicated that treatment-naïve patients might experience reduced pain with the addition of the proparacaine pledget.

Conclusions:

• Adjunctive use of a proparacaine-soaked pledget does not significantly improve pain relief compared to topical proparacaine drops alone for intravitreal injections.
• The findings suggest a potential benefit for treatment-naïve patients, warranting further investigation.
• Current anesthetic protocols for IVI may not require the addition of proparacaine pledgets for most patients.