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PurposeTo assess safety and efficacy of deep topical anesthesia with ropivacaine-soaked sponge compared with topical anesthesia with oxybuprocaine in patients undergoing phacoemulsification.MethodsThis was a retrospective study where records of patients operated for cataract were evaluated. Patients using a visual analogue scale scored pain during surgery, and the surgeon on a questionnaire recorded ease of operation. Medical records were evaluated for patients who received topical anesthesia with multiple administrations of oxybuprocaine 0.4% or those who received deep topical anesthesia with a polyvinyl acetal sponge impregnated with ropivacaine 0.75% and positioned under the eyelid 30 min before surgery.ResultsA total of one hundred patient records, equally divided in patients receiving deep topical anesthesia or topical anesthesia, were included. The visual analogue scale scores among the groups were statistically significant for a lower pain score in patients who received deep topical anesthesia with ropivacaine-soaked sponges (p = 0.0069). The average surgeon score was significantly higher for the deep topical anesthesia group indicating favorable ease of surgery (p = 0.0341). Six patients had major complications during surgery. No additional anesthesia was necessary to manage the complications in four patients in the deep anesthesia group, whereas propofol was used for the induction and maintenance of anesthesia in two patients in the topical anesthesia group.ConclusionsDeep topical anesthesia with ropivacaine-soaked sponges performed as well as topical oxybuprocaine regarding safety and efficacy. It provided a lower patient pain score, favorable surgeon satisfaction, and long-lasting anesthesia.

Purpose: To compare the effectiveness of topical and sub-Tenon′s anesthesia in providing pain relief during phacoemulsification. Methods: This randomized controlled trial was carried out at a tertiary eye care hospital, Coimbatore, Tamil Nadu, India. Patients who underwent phacoemulsification through self-sealing clear corneal incision with foldable intra-ocular lens implantation were randomized into two groups. Group 1 (n = 100) received topical anesthesia with 0.5% proparacaine (Paracaine, Sunways India Pvt. Ltd., India) drops. Group 2 (n = 100) received sub-Tenon′s infiltration with 2% lignocaine (Xylocaine, AstraZeneca Pharma India Pvt. Ltd., India). As per study criteria, patients graded the pain during administration of anesthesia, during surgery and after surgery on a visual analogue pain scale. The surgeon graded overall patient co-operation. The complications were also noted. Data analysis was performed using Statistical Package for Social Sciences version 11. Student′s t-test and Chi-square test were used for comparison of variables between the groups. Results: Sub-Tenon′s anesthesia provided statistically significant better intra-operative pain relief and patient satisfaction than topical anesthesiat. No statistically significant difference was noted between the two groups regarding pain during administration, postoperative pain, and surgeon satisfaction. Conclusion: Sub-Tenon′s anesthesia provides better pain relief than topical anesthesia during phacoemulsification.

To compare anterior chamber depth and postoperative visual outcome in patients undergoing phacoemulsification under topical vs peribulbar anesthesia. Prospective, randomized, comparative observational study.Sample size: 110 eyes with 55 eyes each. Group I: Patients undergoing phacoemulsification under topical anesthesia.Group II: Patients undergoing phacoemulsification under peribulbar anesthesia.Once patients were selected, baseline a standard ophthalmic examination was done including best-corrected visual acuity (BCVA), refraction, IOP by NCT, anterior segment evaluation with slit lamp biomicroscopy, keratometry, axial length, and ACD measurement by IOL master. Post-operatively, the patients were reviewed at day 1, week 1, week 6 for the same parameters.Statistics:Quantitative variables: Paired and unpaired -test.Qualitative variables: Chi square test.A -value of <0.05 was considered statistically significant. Inter-group comparisons of post-operative change in ACD at 1-week post-op ( -value<0.001) and 6-week post-op ( -value<0.001) were statistically significant when compared to the pre-op values. The mean spherical equivalent in group I was 0.27±0.26 d and that in group II was 1±0.32 d at 1-week post-op. The mean spherical equivalent in group I was 0.23±0.20 d, while that in group II was 0.85±0.64 d at 6-week post-op. This difference was statistically significant both at 1-week post-op ( -value=0.002) and 6-week post-op ( -value<0.001). Post-phacoemulsification, the ACD is more after peribulbar anesthesia as compared to topical anesthesia. Post-op refractive outcome is better with the use of topical anesthesia.

Ghazal Valizadeh,1,2 Elliot Duong,3 Christopher Thang,2– 4 Leigh D White3,4 1Department of Ophthalmology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; 2Faculty of Medicine, University of Queensland, Herston, Queensland, Australia; 3Department of Anesthesia and Perioperative Medicine, Sunshine Coast University Hospital, Birtinya, Queensland, Australia; 4School of Medicine, Griffith University, Birtinya, Queensland, AustraliaCorrespondence: Ghazal Valizadeh, Department of Ophthalmology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia, Email ghazal.valizadeh@health.qld.gov.auBackground: Sub-Tenon’s and topical anesthesia are the most common anesthetic techniques employed for cataract surgery. The objectives were to compare the effectiveness of intraoperative analgesia between the two techniques.Methods: A systematic review was performed of three databases (MEDLINE, EMBASE, CENTRAL) from inception until August 2023. Included were adult patients undergoing routine cataract surgery with sub-Tenon’s or topical anesthesia. Excluded were studies using systemic medications and complicated surgeries. The primary outcome was intraoperative analgesia assessed by patient reported pain scores. Secondary outcomes were post-operative pain at 30 minutes and 24 hours, patient satisfaction, surgeon satisfaction and complications. Risk of bias was evaluated using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Outcomes were statistically assessed with meta-analyses where able.Results: Twelve studies with 1370 patients were included in the meta-analysis. Sub-Tenon’s block provided better intraoperative analgesia with lower pain scores (SMD − 0.53, 95% CI − 0.70 to − 0.36; p < 0.001) which remained significant on subgroup analysis of six studies with uniform pain scales (MD − 0.84, 95% CI − 1.22 to − 0.47; p < 0.001). Instances of severe intraoperative discomfort requiring rescue regional anesthesia were reported with topical anesthesia. While there was no difference in pain scores at 30 minutes or 24 hours post-operatively, higher patient and surgeon satisfaction was found with sub-Tenon’s anesthesia. Serious complications were rare, with a higher reported rate of posterior capsule rupture with topical anesthesia. Only two of fourteen studies were considered an overall low risk-of-bias.Conclusion: Sub-Tenon’s block provides marginally better intraoperative analgesia during cataract surgery over topical anesthesia. Both can be considered effective for uncomplicated cataract surgery.Keywords: sub-Tenon’s, topical anesthesia, regional anesthesia, cataract surgery

The pain and fear caused by direct local injection of anesthetic or the poor experience with surface anesthetic cream increase the difficulty of clinical treatment for oral diseases. To address this problem, a hyaluronic acid microneedle patch (Li-HAMNs) that consists of fast-dissolving lidocaine hydrochloride (LDC)-loaded tips and a wet-adhesive backing layer made of polyvinyl alcohol (PVA)/carboxymethylcellulose sodium (CMC-Na) was fabricated to explore its potential use in dental topical anesthesia. Li-HAMNs could puncture the stratum corneum with an insertion depth of about 279 μm in the isolated porcine oral mucosal. The fast-dissolving tips could release LDC to improve the patients’ convenience and compliance. Importantly, the backing layer, which has good adhesion ability and water-absorbing properties, could surmount the contraction and extension of oral masticatory muscles and the saliva scour. In the tail flick test, the topical anesthesia efficacy of the Li-HAMNs group was much better than clinical lidocaine cream (EMLA cream, LDC, 1.2 mg) in spite of a relatively lower LDC dose with Li-HAMNs (LDC, 0.5 mg). It is believed that the proposed adhesive microneedle patch could enhance transmucosal delivery of anesthetics and thus open a new chapter in the painless treatment of oral diseases.

Background One of the main goals for pediatric dentists is to offer a painless anesthesia experience. Laser photobiomodulation is among the suggested strategies to decrease injection pain. So, this study aimed to assess the impact of laser photobiomodulation on local anesthesia (LA) injection pain in children and its effect on the efficacy of LA during pulpotomy and SSC procedures. Methods The research was carried out as a randomized controlled clinical trial with two parallel group design. It involved 64 cooperative healthy children, age range from 5 to 7 years, each having at least one maxillary molar indicated for pulpotomy. Children were randomly allocated to one of the two groups based on the pre-anesthetic tissue management technique used: test group received laser photobiomodulation, while control group received topical anesthetic gel. Pain during injection, pulpotomy, and SSC procedures was assessed using physiological measures (Heart Rate (HR)), subjective evaluation (modified Face-Pain‐Scale (FPS), and objective analysis (Sound‐Eye‐Motor scale (SEM)). Results A total of 64 children with mean age 6.23 ± 0.78 participated in this research. The mean HR scores were significantly lower in the laser PBM group during buccal and palatal infiltration injections. The SEM mean scores were significantly lower in the laser PBM group during both injections. For the FPS scale, the number of children who recorded satisfaction during injection was significantly higher in laser PBM group. There was no statistically significant difference in mean HR as well as in SEM and FPS scores between the two groups during pulpotomy and SSC procedures. Comparisons between the two study groups were performed using independent samples t- and Mann-Whitney U tests. Significance was set at p value < 0.05. Conclusion Laser photobiomodulation is a promising non-pharmacological pre-anesthetic tissue management technique in children that offered less painful injection compared to topical anesthetic gel without compromising the effectiveness of LA. Trial Registration ClinicalTrials.gov Identifier: NCT05861154. Registered on 16/5/2023. Graphical Abstract

Topical anesthesia is widely used in dentistry. However, its clinical effectiveness remains controversial. This study conducted a bibliometric analysis of the most cited clinical dentistry articles on topical anesthesia, identifying the most studied drugs, research trends, leading authors, geographic distribution, funding sources, and study characteristics. A structured search was conducted in the Web of Science using defined descriptors and Boolean operators, with citation comparisons in Scopus and Google Scholar. The search, conducted without language or publication year restrictions, extended until October 2023. Out of 4892 articles, the 30 most cited were selected, collectively accumulating 953 citations between 1992 and 2017. Most highly cited and funded studies originated from the United States. Journals focusing on periodontics, general dentistry, and oral surgery published the majority of these articles, with lidocaine being the most studied anesthetic. Despite their widespread use, topical anesthetics have garnered relatively few citations. Our findings suggest a research preference for studies with immediate clinical impact over those focusing on pain management, particularly in the field of topical dental anesthesia. This highlights the need for further research and progress in this important field.

Background/aim: Sub-Tenon’s block (STB) or topical anaesthesia alone (TOP) are popular techniques employed during cataract surgery. TOP is often preferred by healthcare providers because of financial or staffing reasons, despite existing evidence that pain during surgery is better controlled with STB. Pain is not the only consideration that determines patient preference for the anaesthesia technique. The authors decided to investigate the issue of patient satisfaction using the recently developed Iowa Satisfaction with Anesthesia Scale (ISAS). Method: In a randomised controlled pilot trial, 28 patients were enrolled to receive either STB with 3 ml of 2% lidocaine and hyaluronidase, or TOP with proxymetacaine 0.5% and amethocaine 1% (Tetracaine) eye drops. Postoperatively patients rated their satisfaction with anaesthesia care by filling in the self administered written questionnaire, the ISAS. Results: One patient in the TOP group dropped out of the study because of intolerable pain. Analysis of the questionnaire results with a two sample Wilcoxon rank sum test showed a significant difference in patient satisfaction (p<0.0085). The median satisfaction score was higher in the STB group 2.77 (interquartile range IQR 2.45 to 3), than in the TOP group 2.04 (IQR 1.54 to 2.5). Conclusion: In the setting of day case cataract surgery, patients report significantly higher satisfaction scores with STB than with TOP alone.

Objective To evaluate whether sub-Tenon anesthesia used during cataract surgery has a potential effect on pupillary dynamics by assessing late-term pupillary responses, and to compare these outcomes with those under topical anesthesia to ensure the safety of sub-Tenon anesthesia. Methods The medical records of 63 eyes of 63 patients aged 50–70 who underwent cataract surgery between January 2022 and December 2023 were retrospectively analyzed. Demographic data and medical histories were reviewed. Comprehensive eye examinations including visual acuity, biomicroscopic and detailed fundus examination, and pupillography measurements (photopic, mesopic, scotopic, and dynamic responses) were recorded preoperatively and at postoperative week 1 follow-up. Results The mean ages of patients in the topical and sub-Tenon anesthesia groups were 67.25 ± 10.29 and 68.84 ± 9.31 years, respectively. A total of 21 patients were male and 42 were female. Topical anesthesia was applied to 31 eyes and sub-Tenon anesthesia to 32 eyes. Both groups showed significant changes in pre- and postoperative scotopic, mesopic, and dynamic 10-second pupillary responses ( p  < 0.05). However, there was no statistically significant difference in static and dynamic pupil diameters between the two groups ( p  > 0.05). Conclusions Sub-Tenon’s anesthesia does not cause clinically significant changes in pupillary dynamics one week postoperatively, suggesting it is a safe alternative to topical anesthesia in terms of autonomic pupillary response.

Sub-Tenon's and topical anesthesia are the most common anesthetic techniques employed for cataract surgery. The objectives were to compare the effectiveness of intraoperative analgesia between the two techniques. A systematic review was performed of three databases (MEDLINE, EMBASE, CENTRAL) from inception until August 2023. Included were adult patients undergoing routine cataract surgery with sub-Tenon's or topical anesthesia. Excluded were studies using systemic medications and complicated surgeries. The primary outcome was intraoperative analgesia assessed by patient reported pain scores. Secondary outcomes were post-operative pain at 30 minutes and 24 hours, patient satisfaction, surgeon satisfaction and complications. Risk of bias was evaluated using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Outcomes were statistically assessed with meta-analyses where able. Twelve studies with 1370 patients were included in the meta-analysis. Sub-Tenon's block provided better intraoperative analgesia with lower pain scores (SMD -0.53, 95% CI -0.70 to -0.36; p < 0.001) which remained significant on subgroup analysis of six studies with uniform pain scales (MD -0.84, 95% CI -1.22 to -0.47; p < 0.001). Instances of severe intraoperative discomfort requiring rescue regional anesthesia were reported with topical anesthesia. While there was no difference in pain scores at 30 minutes or 24 hours post-operatively, higher patient and surgeon satisfaction was found with sub-Tenon's anesthesia. Serious complications were rare, with a higher reported rate of posterior capsule rupture with topical anesthesia. Only two of fourteen studies were considered an overall low risk-of-bias. Sub-Tenon's block provides marginally better intraoperative analgesia during cataract surgery over topical anesthesia. Both can be considered effective for uncomplicated cataract surgery.