title: Differences in pain experience and cooperation between consecutive surgeries in patients undergoing phacoemulsification.
abstract: The purpose of this study is to compare pain experience and cooperation between consecutive surgeries in patients undergoing phacoemulsification in both eyes, using sub-Tenon's local anesthesia without sedation. In this study, 268 patients with bilateral senile cataracts were recruited. All operations were performed without sedation, using a clear corneal phacoemulsification technique and sub-Tenon's local anesthesia, by one of four surgeons. The first surgery was performed on the eye with the higher grade cataract. The other eye was operated on within 3 months by the same surgeon (mean interval 1.9 ± 1.1 months). All patients were asked to grade their pain experience during induction and maintenance of anesthesia and also during the phacoemulsification surgery, using a visual analogue scale (VAS) from 0 (no pain) to 10 (unbearable pain) administered after the surgery. The cooperation of the patient was graded from 0 (no event) to 3 (markedeye and head movement and lid squeezing) by the attending surgeon. The VAS scores and cooperation scores of the patients were the outcome measurements. The mean pain score was 2.11 ± 0.79 in the first eye and 3.33 ± 0.80 in the second eye during the administration of sub-Tenon's anesthesia, and 1.50 ± 0.60 in the first eye and 2.10 ± 0.57 in the second eye during the phacoemulsification surgery. The patient cooperation score was 1.60 ± 0.75 in the first surgery and 2.08 ± 0.72 in the second surgery. The differences between the first and second surgeries were statistically significant for all outcome measures (p < 0.01). Patients who previously underwent phaco surgery in one eye experienced more pain and showed worse cooperation during the phaco surgery in the second eye, especially if there was a short time between the surgeries, viz., less than 3 months. Therefore, if the surgeon has difficulty in the first operation gaining the patient's cooperation, the surgeon must be careful: if contralateral eye surgery is required, the addition of sedation/analgesia should be considered or the surgery postponed for a while to abolish the influence of recent memory on the patient's subsequent pain experience.
authors.affiliation: Ophthalmology Department, Fatih Sultan Mehmet Training and Research Hospital, E-5 Üzeri, Üst Bostanci, Istanbul, Turkey. drsezenakkaya@gmail.com.|, Salacak Mah. Fıstıklı Namazgah Sok. No: 3, Konakkaya. ,Üsküdar, Istanbul, Turkey. drsezenakkaya@gmail.com.
authors.forename: Sezen
authors.initials: S
authors.lastname: Akkaya
authors.affiliation: Ophthalmology Department, Fatih Sultan Mehmet Training and Research Hospital, E-5 Üzeri, Üst Bostanci, Istanbul, Turkey.
authors.forename: Yelda Buyru
authors.initials: YB
authors.lastname: Özkurt
authors.affiliation: Ophthalmology Department, Fatih Sultan Mehmet Training and Research Hospital, E-5 Üzeri, Üst Bostanci, Istanbul, Turkey.
authors.forename: Sibel
authors.initials: S
authors.lastname: Aksoy
authors.affiliation: Ophthalmology Department, Fatih Sultan Mehmet Training and Research Hospital, E-5 Üzeri, Üst Bostanci, Istanbul, Turkey.
authors.forename: Hatice Kübra
authors.initials: HK
authors.lastname: Kökçen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D010349:Patient Compliance; D018918:Phacoemulsification / Q000379:methods*; D010817:Physician-Patient Relations; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local
keywords: Cooperation; Pain; Patient; Phaco surgery