The Comparison of PostOperative Pain between Topical Anesthesia and Monitored Anesthesia Care in Cataract Surgery

Seon Do Kim; Jin Ho Jeong

doi:10.7469/JKOS.2015.56.05.715

Journal List > J Korean Ophthalmol Soc > v.56(5) > 1010272

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim and Jeong: The Comparison of PostOperative Pain between Topical Anesthesia and Monitored Anesthesia Care in Cataract Surgery

Original Article

J Korean Ophthalmol Soc 2015;56(5):715-720.

Published online: 7 September 2015

DOI: https://doi.org/10.7469/JKOS.2015.56.05.715

The Comparison of PostOperative Pain between Topical Anesthesia and Monitored Anesthesia Care in Cataract Surgery

Seon Do Kim, MD, Jin Ho Jeong, MD, PhD

Department of Ophthalmology, Jeju National University School of Medicine, Jeju, Korea

￭ Address reprint requests to Jin Ho Jeong, MD, PhD Department of Ophthalmology, Jeju National University Hospital, Jeju National University School of Medicine, #15 Aran-13-gil, Jeju 690-767, Korea Tel: 82-64-717-1362, Fax: 82-64-717-1102 E-mail: amario@naver.com

Received 5 December 20149 April 2015 Accepted 20 April 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose:

To compare pain levels in cataract surgery under topical anesthesia only and topical anesthesia under monitored anesthesia care.

Methods:

We recruited 243 patients who were scheduled to undergo cataract surgery under topical anesthesia only or topical anesthesia with monitored anesthesia care (MAC) using fentanyl and midazolam. Anesthesia methods were selected based on the patient’s preference. All patients completed an anxiety and information scale survey preoperatively. Vital signs during the operations were recorded. A 0-to-10 visual analog scale pain score survey was conducted immediately and at 2 hours, 6 hours, and 1 day after surgery.

Results:

Of the 237 patients who completed the study, 183 patients selected topical anesthesia, and 54 patients selected MAC. Mean pain scores according to the aforementioned time points after surgery were 0.50, 0.58, 0.29, and 0.12 in the topical anesthesia group, and 0.22, 0.16, 0.06, and 0.09 in the MAC group, respectively. The differences in pain score between the two groups was statistically significant at 2 hours ( p = 0.019) and 6 hours ( p = 0.040) after surgery. The mean patient anxiety score for anesthesia was 10.50 in the topical anesthesia group and 11.41 in the MAC group ( p = 0.280). Mean systolic blood pressure at the start of surgery was 140.6 mm Hg in the topical anesthesia group, and 158.2 mmHg in the MAC group.

Conclusions:

Monitored anesthesia care consistently resulted in less pain throughout the postOperative period. However, transient systolic blood pressure should be carefully monitored for a rise related to intravenous anesthetics.

Keywords: Cataract surgery, Monitored anesthesia care, Pain

References

1. Apil A, Kartal B, Ekinci M, et al. Topical anesthesia for cataract surgery: the patients' perspective. Pain Res Treat. 2014; 2014:827659.

2. Yoon KC, Cho CW, Seo MS, Yang KJ. Comparision of ocular pain between topical and retrobulbar anesthesia for cataract surgery. J Korean Ophthalmol Soc. 1996; 37:2041–7.

3. Ryu JH, Kim M, Bahk JH, et al. A comparison of retrobulbar block, sub-Tenon block, and topical anesthesia during cataract surgery. Eur J Ophthalmol. 2009; 19:240–6.

4. Wagle AA, Wagle AM, Bacsal K, et al. Practice preferences of ophthalmic anaesthesia for cataract surgery in Singapore. Singapore Med J. 2007; 48:287–90.

5. Paik HJ, Song HJ, Shyn KH. 2007 Survey for KSCRS members: current trends in cataract surgery in Korea. J Korean Ophthalmol Soc. 2009; 50:1624–31.

6. Fichman RA. Use of topical anesthesia alone in cataract surgery. J Cataract Refract Surg. 1996; 22:612–4.

7. Seo JB, Byun SW, Kim JH, Joo CK. Comparison of effects of topical, pinpoint and retrobulbar anesthesin in cataract surgery using clear corneal incision. J Korean Ophthalmol Soc. 1998; 39:1716–22.

8. Lee JS, Chung SK, Baek NH. Topical versus retrobulbar anesthesia in clear corneal cataract surgery. J Korean Ophthalmol Soc. 1999; 40:3031–7.

9. Lee JH, Yoo JH, Cho SH, et al. Thyroid surgery under monitored anesthesia care (MAC). Korean J Anesthesiol. 2009; 56:284–9.

10. Lee Y, Chang HW, Shim JY. The effect of combined fentanyl and ketamine administration in the monitored anesthetic care of ambu-latory strabismus surgery. Korean J Anesthesiol. 2006; 50:434–8.

11. Rosenfeld SI, Litinsky SM, Snyder DA, et al. Effectiveness of monitored anesthesia care in cataract surgery. Ophthalmology. 1999; 106:1256–60. discussion 1261.

12. Zakrzewski PA, Banashkevich AV, Friel T, Braga-Mele R. Monitored anesthesia care by registered respiratory therapists during cataract surgery: an update. Ophthalmology. 2010; 117:897–902.

13. Moerman N, van Dam FS, Muller MJ, Oosting H. The Amsterdam preoperative anxiety and information scale (APAIS). Anesth Analg. 1996; 82:445–51.

14. Porela-Tiihonen S, Kaarniranta K, Kokki M, et al. A prospective study on postoperative pain after cataract surgery. Clin Ophthalmol. 2013; 7:1429–35.

15. Ko JS, Ahn JM, Seo KY, et al. Relationship between cataract matu-ration and pain scale during cataract surgery under topical anesthesia. J Korean Ophthalmol Soc. 2013; 54:437–42.

16. Ursea R, Feng MT, Zhou M, et al. Pain perception in sequential cataract surgery: comparison of first and second procedures. J Cataract Refract Surg. 2011; 37:1009–14.

17. Cakmak H, Kocaturk T, Dundar SO, et al. The effects of diazepam on blood pressure levels in cataract surgery. Saudi Med J. 2014; 35:669–73.

Figure 1.

Subjective postOperative pain score using 0-to-10 Visual Analogue Scale (VAS) Cataract surgery using MAC consistently offered less pain throughout the postOperative period and the difference was statistically significant at postop 2 hour and 6 hour. MAC = monitored anesthesia care; op = operation. ^* Statistically significant ( p < 0.05).

Table 1.

Questionnaire based on the Amsterdam Preoperative Anxiety and Information Scale (APAIS)

Item	Survey title	Grade
Item	Survey title	1	2	3	4	5
1	I am worried about the anesthetic.	□	□	□	□	□
2	The anesthetic is on my mind continually.	□	□	□	□	□
3	I would like to know as much as possible about the anesthesia.	□	□	□	□	□
4	I am worried about the procedure.	□	□	□	□	□
5	The procedure is on my mind continually.	□	□	□	□	□
6	I would like to know as much as possible about the procedure.	□	□	□	□	□

The measure of agreement with these statements should be graded on a five-point Likert scale from 1 = not at all to 5 = extremely. Anxiety scale consists of item 1, 2, 4, 5. Information scale consists of item 3, 6.

Table 2.

Demographics of the patients

Group	Topical anesthesia only	Topical anesthesia + MAC	Total
N	183	54	237
Age (years)	68.4 ± 10.96	71.6 ± 7.11	69.1 ± 10.91
M:F (%)	41:59	34:66	39:61
Cataract nucleus opacity	2.80 ± 0.89	2.98 ± 0.98	2.84 ± 0.93

Values are presented as mean ± SD unless otherwise indicated.

MAC = monitored anesthesia care.

Table 3.

Patient anxiety scale

Group	Anxiety for anesthesia (APAIS item 1, 2)	Anxiety for procedure (APAIS item 4, 5)	Anxiety score (APAIS item 1, 2, 4, 5)
Topical anesthesia only	4.97 ± 2.09/10	5.53 ± 2.27/10	10.50 ± 4.10/20
Topical anesthesia + MAC	5.50 ± 2.45/10	5.91 ± 2.58/10	11.41 ± 4.49/20
t test between group (significance)	p = 0.226	p = 0.354	p = 0.280

Values are presented as mean ± SD unless otherwise indicated.

APAIS = Amsterdam preoperative anxiety and information scale; MAC = monitored anesthesia care.

Table 4.

Vital signs measured during the operation

Group	Topical anesthesia only	Topical anesthesia + MAC	t-test between group (Significance)
When operation started
HR	68.49 ± 10.86	67.03 ± 11.66	p=0.080
SBP (mm Hg)	140.63 ± 16.12	158.24 ± 21.24	p<0.001^*
DBP (mm Hg)	80.04 ± 8.97	78.30 ± 9.69	p=0.366
When operation ended
HR	67.55 ± 10.43	62.58 ± 10.00	p=0.011^*
SBP (mm Hg)	139.14 ± 18.17	140.21 ± 20.39	p=0.947
DBP (mm Hg)	79.10 ± 9.74	72.00 ± 10.89	p<0.001^*

MAC = monitored anesthesia care; HR = heart rate per minute; SBP = systolic blood pressure; DBP = diastolic blood pressure.

^* Statistically significant ( p < 0.05).

Table 5.

Bivariate correlation analysis of postOperative pain score with various preoperative and intraoperative factors

Factors		Age	Gender	NO	Anes. Anxiety	Proc. Anxiety	NPO time	OP order	OP time	HR at start	SBP at start	DBP at start	HR at end	SBP at end	DBP at end
Pain at 0 hour	Pearson	-0.005	-0.021	-0.059	0.086	0.099	-0.052	-0.053	0.341	0.140	-0.077	-0.045	0.096	-0.055	-0.035
Pain at 0 hour	Sig.	0.936	0.744	0.368	0.186	0.129	0.423	0.419	0.000^*	0.031^*	0.235	0.490	0.141	0.402	0.587
Pain at 2 hours	Pearson	-0.072	0.008	-0.076	0.119	0.153 ^*	-0.031	-0.016	0.233^*	0.109	-0.065	-0.061	0.097	-0.033	0.059
Pain at 2 hours	Sig.	0.269	0.899	0.246	0.067	0.018^*	0.637	0.803	0.000^*	0.094	0.321	0.353	0.135	0.615	0.363
Pain at 6 hours	Pearson	-0.130	-0.056	-0.081	-0.025	-0.028	-0.113	-0.038	0.131	0.049	0.04	-0.057	0.072	0.022	0.018
Pain at 6 hours	Sig	0.045^*	0.392	0.214	0.697	0.669	0.082	0.563	0.044^*	0.455	0.539	0.385	0.27	0.741	0.784
Pain at 1 day	Pearson	-0.135	0.030	0.011	0.071	0.068	-0.06	0.011	0.283	0.076	0.026	0.023	0.014	-0.027	-0.043
Pain at 1 day	Sig	0.038^*	0.647	0.865	0.275	0.299	0.359	0.870	0.000^*	0.243	0.693	0.72	0.833	0.683	0.506

NO = cataract nucleus opacity; Anes. Anxiety = anxiety for anesthesia; Proc. Anxiety = anxiety for procedure; NPO = nothing per oral; OP = operation; HR = heart rate; SBP = systolic blood pressure; DBP = diastolic blood pressure; Sig. = significance.

^* Statistically significant ( p < 0.05).

TOOLS

Similar articles