Abstract
Ophthalmic surgery has developed enormously over the past few years. Topical anesthesia is a safe and current procedure in cataract surgery, giving patients quicker and more comfortable recovery. Some authors have used this type of anesthesia for trabeculectomy with good results. This study aims to assess the patient's pain and comfort during and 1 day after nonpenetrating deep sclerectomy compared to peribulbar anesthesia. A visual analog pain scale (0-10) was applied to 69 patients 15 min and 24 h after a nonpenetrating deep sclerectomy procedure. Topical anesthesia (proximetacaine 0.5% drops) associated with an intravenous sedation with propofol was used in 36 patients (group 1) and peribulbar anesthesia (lidocaine 2% associated with bupivacaine 0.75%) was given to 33 patients (group 2) in a randomized and prospective way. The surgical team was the same for all procedures. Results were compared using a Mann-Whitney U test. Mean age (+/- standard deviation) was 60.25+/-15.90 years in group 1 and 59.15+/-15.36 years in group 2 (p=0.871). For the first evaluation (15 min after surgery), the mean values and their respective deviations were the following: 0.11 +/- 0.40 (0-2) in group 1 and 0.82+/-1.49 (0-5) in group 2 (p=0.014). After 24 h, the mean values and deviations were as follows: 2.83 +/- 1.34 (1-6) in group 1 and 2.45+/-2.09 (0-8) in group 2 (p=0.125). Pain perception by the patient undergoing nonpenetrating deep sclerectomy was statistically different between the two groups in the first evaluation (15 min after the procedure). The topical anesthesia (associated with propofol sedation) group had less pain sensation. The first 24 h assessment showed no significant difference between the groups. Topical anesthesia (associated with propofol sedation) is a valuable and interesting alternative for patients undergoing nonpenetrating deep sclerectomy, providing the same or slightly better comfort than peribulbar anesthesia.
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