KATARAKT CERRAHİSİ SIRASINDA TOPİKAL ANESTEZİ İLE BÖLGESEL ANESTEZİ UYGULANAN HASTALARIN AĞRI SKORLARININ KARŞILAŞTIRILMASI

Amaç: Bu çalışmanın amacı fakoemülsiŞkasyon cerrahisi ve intraoküler lensin implantasyonu aşamasında hissedilen ağrının topikal, intrakameral veya subtenon lidokain ile uygulanan anestezi yöntemlerinden etkilenip etkilenmediğini incelemektir. Yöntem: Bu retrospektif çalışmada katarakt cerrahisi uygulanan dört yüz elli hasta çalışmaya alındı. Tüm hastalara cerrah tarafından uygun görülen topikal (n=150), subtenon (n=150), veya intrakameral anestezi (n=150) kullanılarak fakoemülsiŞkasyon cerrahisi ve intraoküler lens implantasyonu uygulandı. Topikal gruba %4 lidokain damla; intrakameral gruba topikal lidokain damlaları ile birlikte ön kamaraya %1‘lik koruyucu içermeyen 0.1-0.2 cc lidokain verildi. Subtenon gruba %2'lik lidokain verildi. İntraoperatif ağrı düzeyi sözel ağrı skalası (VPS-Verbal Pain Scale) ve görsel analog skala (VAS-Visual Analog Scale) ile değerlendirildi. Bulgular: Subtenon grubundaki ortalama ağrı skoru, topikal ve intrakameral gruplara göre anlamlı olarak daha düşük bulundu (sırasıyla p = 0.0009 ve p = 0.0055). İntraoperatif ve postoperatif ağrı düzeyleri ile yaş veya cinsiyet arasında istatistiksel olarak anlamlı bir ilişki bulunamadı. Sonuç: Katarakt ameliyatı için, intrakameral ve topikal lidokainin yeterli ağrı bastırma etkisi olmasına rağmen, subtenon anestezinin ameliyat esnasında ve sonrasında daha uygun olduğu gözlemlendi.

COMPARISION OF PAIN SCORES OF PATIENTS WHO UNDERWENT TOPICAL ANESTHESIA OR REGIONAL ANESTHESIA DURING CATARACT SURGERY

Objective: The aim of this study is to investigate the pain sensation differences in the anesthesia methods applied with topical, intracameralor subtenon lidocaine pain experienced during cataract surgery (phacoemulsiŞcation and intraocular lens implantation) Method: This is a retrospective study. Four hundred and Şfty patient undergoing cataract surgery were included in this study. PhacoemulsiŞcation surgery and intraocular lens implantation were performed using topical (n = 150), subtenon (n = 150), or intracameral anesthesia (n = 150). Topical group received 4% lidocaine drop; intracameral group was given 0.1-0.2 cc of 1% lidocaine with no preservative in the anterior chamber with topical lidocaine drops. The subtenon group received 2% lidocaine. Intraoperative pain level was assessed by verbal pain scale (VPS-Verbal PainSscale) and visual analog scale (VAS-Visual Analog Scale).

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21. Şchman RA. Use of topical anesthesia alone in cataract surgery. J Cataract Refract Surg 1996; 22: 612-614.
20. Roman SJ, Chong Sit DA, Boureau CM, Auclin FX, Ullern MM. Sub-Tenon's anaesthesia: an efŞcient and safe technique. Br J Ophthalmol 1997; 81: 673-676.
19. Stevens JD. A new local anesthesia technique for cataract extraction by one quadrant sub-Tenon's inŞltration. Br J Ophthalmol 1992; 76: 670-674.
18. Srinivasan S, Fern AI, Selvaraj S, Hasan S. Randomized double-blind clinical trial comparing topical and sub-Tenon's anaesthesia in routine cataract surgery. Br J Anaesth 2004; 93: 683-686.
17. Davidson M, Padroni S, Bunce C, Ruschen H. Sub-Tenon's anaesthesia versus topical anaesthesia for cataract surgery. Cochrane Database Syst Rev. 2007; 18: CD006291.
16. Ezra DG, Nambiar A, Allan BD. Supplementary intracameral lidocaine for phacoemulsiŞcation under topical anesthesia: a meta-analysis of randomized controlled trials. Ophthalmology 2008; 115: 455-487.
15. Crandall AS, Zabriskie NA, Patel BC, et al. A comparison of patient comfort during cataract surgery with topical anesthesia versus topical anesthesia and intracameral lidocaine. Ophthalmology 1999; 106: 60-66.
14. Gombos K, Jakubovits E, Kolos A, Salacz G, Németh J. Cataract surgery anaesthesia: is topical anaesthesia really beter than retrobulbar? Acta Ophthalmol Scand 2007; 85: 309-316.
13. Tan CS, Fam HB, Heng WJ, Lee HM, Saw SM, AuEong KG. Analgesic effect of supplemental intracameral lidocaine during phacoemulsiŞcation under topical anaesthesia: a randomised controlled trial. Br J Ophthalmol 2011; 95: 837-841.
12. Stauffer ME, Taylor SD, Watson DJ, Peloso PM, Morrison A. DeŞnition of non response to analgesic treatment of arthritic pain: an analytical literature review of the smallest detectable difference, the minimal detectable change, and the minimal clinically important difference on the pain visual analog scale. Int J Inşamm 2011; 2011: 231926.
11. Apil A, Kartal B, Ekinci M, et al. Topical anesthesia for cataract surgery: the patients’ perspective. Pain Res Treat 2014; 2014: 827659.
10. Eke T, Thompson JR. Serious complications of local anaesthesia for cataract surgery: a 1 year national survey in the United Kingdom. Br J Ophthalmol 2007; 91: 470-475.
9. Adatia FA, Munro M, Jivraj I, Ajani A, Braga-Mele R. Documenting the subjective patient experience of Şrst versus second cataract surgery. J Cataract Refract Surg 2015; 41: 116-121.
8. Mustapha M, Hamzah MH, Chow SK, et al. Sub-tenon anaesthesia versus intracameral anaesthesia in patients undergoing cataract extraction: a comparative study of the level of pain, visual perception and anxiety. Int J Med Stud 2014; 2: 49-52.
7. Tseng S-H, Chen FK. A randomized clinical trial of combined topical-intracameral anesthesia in cataract surgery. Ophthalmology 1998; 105: 2007-2011.
6. Lofoco G, Ciucci F, Bardocci A, et al. EfŞcacy of topical plus intracameral anesthesia for cataract surgery in highmyopia: randomized controlled trial. J Cataract Refract Surg 2008; 34: 1664-1668.
5. Garcia A, Loureiro F, Limao A, Sampaio A, Ilharco J. Preservative-freelidocaine 1% anterior chamber irrigation as an adjunct to topical anesthesia. J Cataract Refract Surg 1998; 24. 403-406.
4. Koch PS. Anterior chamber irrigation with unpreserved lidocaine 1% for anesthesia during cataract surgery. J Cataract Refract Surg 1997; 23: 551-554.
3. Manners T, Burton R. Randomised trial of topical versus sub-Tenon’s local anaesthesia for small-incision cataract surgery. Eye (Lond) 1996; 10: 367-370.
2. Pandey SK, Werner L, Apple DJ, Agarwal A, Agarwal A, Agarwal S. No-anesthesia clear corneal phacoemulsiŞcation versus topical and topical plus intracameral anesthesia: randomized clinical trial. J Cataract Refract Surg 2001; 27: 1643-1650.
1. Smith R. Cataract extraction without retrobulbar anaesthetic injection. Br J Ophthalmol 1990; 74: 205-207.