title: Comparative study of analgesic effectiveness using three different anesthetic techniques for intravitreal injection of bevacizumab.
abstract: OBJECTIVE
  To compare the analgesic effectiveness and aesthetic appearance associated with topical, subconjunctival, and peribulbar anesthesia for intravitreal bevacizumab injection.
  
  
  METHODS
  Sixty consecutive patients undergoing their first intravitreal bevacizumab injection were randomized to receive one of three forms of anesthesia: proxymetacaine eye drops, subconjunctival injection of 2% xylocaine, and peribulbar injection of 2% xylocaine. Pain associated with the intravitreal injection and with the entire procedure (including anesthesia administration) was recorded using a Visual Analog Scale 15 minutes after intravitreal injection. Anterior segment evaluation was performed 24 hours after injection to measure the number of clock hours of subconjunctival hemorrhage.
  
  
  RESULTS
  Median injection-related pain score was significantly lower in the peribulbar group compared with the topical and subconjunctival groups (P < .05). Median entire procedure pain score was significantly higher in the peribulbar group compared with the topical and subconjunctival groups (P < .05). The median extent of subconjunctival hemorrhage was significantly lower in the topical group compared with the other groups (P < .05).
  
  
  CONCLUSIONS
  Among the three anesthetic techniques, peribulbar anesthesia was associated with greater effectiveness in controlling injection-related pain but was least effective in controlling entire procedure pain. There was no significant difference in pain scores between the topical and subconjunctival groups, and topical anesthesia was associated with less subconjunctival hemorrhage.
authors.affiliation: Ribeirão Preto School of Medicine, São Paulo, Brazil.
authors.forename: Léssia P
authors.initials: LP
authors.lastname: Cintra
authors.forename: Levy R
authors.initials: LR
authors.lastname: Lucena
authors.forename: José A
authors.initials: JA
authors.lastname: Da Silva
authors.forename: Rogério A
authors.initials: RA
authors.lastname: Costa
authors.forename: Ingrid U
authors.initials: IU
authors.lastname: Scott
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jorge
mesh_terms: D000698:Analgesia / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D005260:Female; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000517:prevention & control; D010147:Pain Measurement; D011430:Propoxycaine / Q000008:administration & dosage; D014822:Vitreous Body
chemical_list: D000779:Anesthetics, Local; D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D008012:Lidocaine; C005717:proxymetacaine; D011430:Propoxycaine