First Author: H.T.Makled EGYPT
Co Author(s): A. El-Sawy Habib H. Yassin H. Tulla Makled 0 0 0 0 0 0 0 0 0
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To compare the intraoperative pain scores and vital signs during clear corneal phacoemulsification under topical aneasthesia, topical with oral sedation, and topical with cryoanalgesia.
Sixty patients had phacoemulsification, were randomized into three groups, the first group under topical anesthesia, the second group under topical with preoperative oral sedation, and the last group under topical anesthesia with cryoanalgesia. Uncooperative patients or patients with shallow anterior chambers, poorly dilated pupils or associated glaucoma surgery or another intervention were excluded from our study. Each patient was asked to grade the pain sensitivity intraoperatively on a 4-point visual analog scale. We also evaluated the general patient's discomfort during surgery, patient's discomfort from the microscope light, lid squeezing, the surgeon's satisfaction, total surgical time and the patient's vital signs during the different surgical steps. Comparison among the 3 groups was performed using an analysis of variance.
The surgical time was slightly higher in the topical anesthesia group than in the topical with sedation and topical with cryoanalgesia groups; however the difference was not significant (P=0.593). The mean intraoperative pain score (scale 0 to 3) was higher in the topical anesthesia group than in the topical with sedation and topical with cryoanalgesia groups and the difference was statistically significant (P=0.008). (Two patients in the topical anesthesia group were so apprehensive during the surgery which necessitated the intake of intraoperative intravenous sedation and were excluded from our study and were replaced by another two patients. Most of the patients reported the time of maximally felt pain was near the end of the surgery during the IOL implantation. Regarding the surgeons' satisfaction, they both reported being more satisfied with the cryoanalgesia technique. The systolic and diastolic blood pressures(SBP&DBP respectively) were higher in the topical anesthesia group than in the topical with sedation and topical with cryoanalgesia groups; however the difference was not significant in the DBP (P=0.015), while was statistically significant in the SBP (P=0.000). All patients' blood pressure were tightly controlled and measured preoperatively to be less than 140/80.
Although clear corneal phacoemulsification can be done with topical anesthesia only with experienced surgeons due to great machine advances, however adding sedation or cryoanalgesia to it will increase the comfort of both the surgeon and the patient. However cryoanalgesia is more prefered as it gives nearly similar results to sedation but without adding any risk especially in the elderly.