title: Ocular pain after intravitreal injection.
abstract: OBJECTIVE
  To evaluate the efficacy of different anesthetics and topical anti-inflammatory treatment in patients undergoing intravitreal injections (IVI).
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  Topical tetracaine and lidocaine provide similar anesthesia before IVI. Topical diclofenac does not seem to reduce pain scores after IVI.
authors: Ophthalmology Unit, Palencia Hospital Complex (CAPA), Palencia, Spain.
authors: Maria Rosa
authors: MR
authors: Sanabria
authors: Javier A
authors: JA
authors: Montero
authors: María Victoria
authors: MV
authors: Losada
authors: Marta
authors: M
authors: Fernández-Muñoz
authors: Alicia
authors: A
authors: Galindo
authors: Itziar
authors: I
authors: Fernández
authors: Rosa M
authors: RM
authors: Coco
authors: Ana
authors: A
authors: Sampedro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000068258:Bevacizumab; D004008:Diclofenac / Q000008:administration & dosage; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D058447:Eye Pain / Q000188:drug therapy / Q000517:prevention & control*; D005260:Female; D006801:Humans; D058449:Intravitreal Injections / Q000009:adverse effects*; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009278:Naphazoline / Q000008:administration & dosage; D014663:Nasal Decongestants / Q000008:administration & dosage; D011446:Prospective Studies; D000069579:Ranibizumab; D012164:Retinal Diseases / Q000188:drug therapy*; D013748:Tetracaine / Q000008:administration & dosage*; D014031:Tobramycin / Q000008:administration & dosage
chemical_list: D000779:Anesthetics, Local; D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D061067:Antibodies, Monoclonal, Humanized; D014663:Nasal Decongestants; D013748:Tetracaine; D004008:Diclofenac; D000068258:Bevacizumab; D008012:Lidocaine; D009278:Naphazoline; D014031:Tobramycin; D000069579:Ranibizumab