Comparison of different topical anesthetic methods for intravitreal injections: a randomized crossover study

Abstract Background To evaluate the potential adjunctive effect of pledget anesthetic to topical proparacaine applied in a droplet form in patients undergoing intravitreal injections (IVI). Method This is a single-centre, prospective, randomized, double-blinded crossover study. 60 patients were incl...

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Main Authors: Jeffrey Man Yeung Lo, Veronica Yui Yan Li, Rachel Ka Ying Cheung, Shing Chuen Chow, Kendrick Co Shih, Nicholas Siu Kay Fung, Wai-Ching Lam
Format: Article
Language:English
Published: BMC 2025-03-01
Series:International Journal of Retina and Vitreous
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Online Access:https://doi.org/10.1186/s40942-025-00649-6
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author Jeffrey Man Yeung Lo
Veronica Yui Yan Li
Rachel Ka Ying Cheung
Shing Chuen Chow
Kendrick Co Shih
Nicholas Siu Kay Fung
Wai-Ching Lam
author_facet Jeffrey Man Yeung Lo
Veronica Yui Yan Li
Rachel Ka Ying Cheung
Shing Chuen Chow
Kendrick Co Shih
Nicholas Siu Kay Fung
Wai-Ching Lam
author_sort Jeffrey Man Yeung Lo
collection DOAJ
description Abstract Background To evaluate the potential adjunctive effect of pledget anesthetic to topical proparacaine applied in a droplet form in patients undergoing intravitreal injections (IVI). Method This is a single-centre, prospective, randomized, double-blinded crossover study. 60 patients were included. Patients receiving IVI were given topical 0.5% proparacaine drops then randomized in a 1:1 ratio to receive 0.5% proparacaine soaked pledget or normal saline soaked pledget as placebo. The patients would later be crossed over to receive the alternative intervention. Pain was assessed with a visual analog scale (VAS) and questionnaire immediately afterwards, 10-minutes and 20-minutes after injection. Result Pain intensity as assessed on the visual analogue scale was lower for the placebo group compared to the pledget group immediately (2.51 cm vs. 2.8 cm), 10-minutes (1.81 cm vs. 2.13 cm) and 20-minutes (1.23 cm vs. 1.65 cm) after injection, however this was not statistically significant (p = 0.48, p = 0.43, p = 0.24 respectively). However, in a subgroup of treatment naïve patients, the addition of pledget anesthesia may lower pain and make IVI more tolerable. Conclusion Additional pledget soaked with proparacaine does not enhance anesthesia compared to solely using topical proparacaine for IVI, except in a subset of treatment naïve patients.
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spelling doaj-art-94a5e04d80494a0e9a5a9fba5a462b942025-08-20T03:40:50ZengBMCInternational Journal of Retina and Vitreous2056-99202025-03-011111710.1186/s40942-025-00649-6Comparison of different topical anesthetic methods for intravitreal injections: a randomized crossover studyJeffrey Man Yeung Lo0Veronica Yui Yan Li1Rachel Ka Ying Cheung2Shing Chuen Chow3Kendrick Co Shih4Nicholas Siu Kay Fung5Wai-Ching Lam6Department of Ophthalmology, Grantham HospitalDepartment of Ophthalmology, School of Clinical Medicine, The University of Hong KongDepartment of Ophthalmology, Grantham HospitalDepartment of Ophthalmology, Grantham HospitalDepartment of Ophthalmology, Grantham HospitalDepartment of Ophthalmology, School of Clinical Medicine, The University of Hong KongDepartment of Ophthalmology, School of Clinical Medicine, The University of Hong KongAbstract Background To evaluate the potential adjunctive effect of pledget anesthetic to topical proparacaine applied in a droplet form in patients undergoing intravitreal injections (IVI). Method This is a single-centre, prospective, randomized, double-blinded crossover study. 60 patients were included. Patients receiving IVI were given topical 0.5% proparacaine drops then randomized in a 1:1 ratio to receive 0.5% proparacaine soaked pledget or normal saline soaked pledget as placebo. The patients would later be crossed over to receive the alternative intervention. Pain was assessed with a visual analog scale (VAS) and questionnaire immediately afterwards, 10-minutes and 20-minutes after injection. Result Pain intensity as assessed on the visual analogue scale was lower for the placebo group compared to the pledget group immediately (2.51 cm vs. 2.8 cm), 10-minutes (1.81 cm vs. 2.13 cm) and 20-minutes (1.23 cm vs. 1.65 cm) after injection, however this was not statistically significant (p = 0.48, p = 0.43, p = 0.24 respectively). However, in a subgroup of treatment naïve patients, the addition of pledget anesthesia may lower pain and make IVI more tolerable. Conclusion Additional pledget soaked with proparacaine does not enhance anesthesia compared to solely using topical proparacaine for IVI, except in a subset of treatment naïve patients.https://doi.org/10.1186/s40942-025-00649-6Intravitreal injectionAnesthesiaPain management
spellingShingle Jeffrey Man Yeung Lo
Veronica Yui Yan Li
Rachel Ka Ying Cheung
Shing Chuen Chow
Kendrick Co Shih
Nicholas Siu Kay Fung
Wai-Ching Lam
Comparison of different topical anesthetic methods for intravitreal injections: a randomized crossover study
International Journal of Retina and Vitreous
Intravitreal injection
Anesthesia
Pain management
title Comparison of different topical anesthetic methods for intravitreal injections: a randomized crossover study
title_full Comparison of different topical anesthetic methods for intravitreal injections: a randomized crossover study
title_fullStr Comparison of different topical anesthetic methods for intravitreal injections: a randomized crossover study
title_full_unstemmed Comparison of different topical anesthetic methods for intravitreal injections: a randomized crossover study
title_short Comparison of different topical anesthetic methods for intravitreal injections: a randomized crossover study
title_sort comparison of different topical anesthetic methods for intravitreal injections a randomized crossover study
topic Intravitreal injection
Anesthesia
Pain management
url https://doi.org/10.1186/s40942-025-00649-6
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