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Topical anaesthesia plus intracameral lidocaine versus topical anaesthesia alone for phacoemulsification cataract surgery in adults
Local anaesthetics in cataract surgery: do eye drops work better with, or without, an injection of anaesthetic? What are cataracts? A cataract starts when cloudy patches develop on the lens of your eye. The lens is a small, clear disc inside the eye that focuses light rays to make clear images of ob...
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| Published in: | Cochrane database of systematic reviews 2020-08, Vol.2020 (7) |
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| creator | Minakaran, Neda Ezra, Daniel G Allan, Bruce DS |
| description | Local anaesthetics in cataract surgery: do eye drops work better with, or without, an injection of anaesthetic?
What are cataracts?
A cataract starts when cloudy patches develop on the lens of your eye. The lens is a small, clear disc inside the eye that focuses light rays to make clear images of objects seen. As the cloudy patches get bigger over time, sight becomes misty and blurred. Cataracts are more common in older people, and can affect your ability to do everyday activities, such as driving. Untreated cataracts will lead to blindness.
How are cataracts treated?
Surgery is the only way to improve your eyesight if you have cataracts. In cataract surgery (phacoemulsification), a tiny cut is made in your eye; the old, cloudy lens is removed and a new, plastic lens is put in its place.
During the operation you are usually awake. Doctors use eye drops containing a numbing medicine (local anaesthetic) to stop the nerves in your eye sending pain signals to your brain during the operation. Sometimes, in addition to anaesthetic eye drops, lidocaine (a type of local anaesthetic) may be injected inside your eye. This may reduce pain during and after the operation.
Why did we do this review?
In this Cochrane Review, we wanted to identify the potential benefits and harms of lidocaine injection into the eye in addition to anaesthetic eye drops during cataract surgery.
What did we do?
In February 2020, we searched for studies that looked at the effects of giving a lidocaine injection and anaesthetic eye drops, compared with giving anaesthetic eye drops alone, during cataract surgery. We looked for randomized controlled studies, a type of study in which treatments are given at random to people in the people in the study because these studies usually give the most reliable evidence about treatments.
Search date:
we included evidence published up to 4 February 2020.
What we found
We found 13 studies in 2355 adults, aged 34 to 95 years, who had cataract surgery in one or both eyes. The studies were conducted in hospitals and eye day‐care centres in the USA, Canada, Australia, the UK, Italy, Taiwan, Singapore, India, and Pakistan.
What are the results of the review?
Compared with giving anaesthetic eye drops alone, lidocaine injection with anaesthetic eye drops probably:
· reduced the level of pain experienced during the operation;
· reduced the number of people who said they felt any pain during their operation;
· did not reduce the level of pain people said they felt |
| doi_str_mv | 10.1002/14651858.CD005276.pub3 |
| format | article |
| fullrecord | <record><control><sourceid>pubmedcentral</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8409260</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>pubmedcentral_primary_oai_pubmedcentral_nih_gov_8409260</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2793-77cd78a65e051bd695c7da036ff9f8d489f5c35a04b010faa4f16f20792e85f43</originalsourceid><addsrcrecordid>eNptkM1KxDAUhYMgOP68guQFOt40TZtsBBl_YcDNCO7KnTSZiaRNSdqBWfviRnQjuDqL79xzOJeQawZLBlDesKoWTAq5XN0DiLKpl-O85SdkkYEqKsXfz8h5Sh8AXDEmF-RzE0an0VMc0KRpb5JDOvo5UTdMETX2JmbqXRc0usHQg4kp0-mfM_QhG2yIdNyjDqaffXI22yYXBpoFc-BE0xx3Jh5zAcVu9lO6JKcWfTJXv3pB3h4fNqvnYv369LK6Wxe6bBQvmkZ3jcRaGBBs29VK6KZD4LW1ysquksoKzQVCtQUGFrGyrLYlNKo0UtiKX5Dbn9z8k9502nwv9O0YXY_x2AZ07V8yuH27C4dWVqDKGvgXkANxgw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Topical anaesthesia plus intracameral lidocaine versus topical anaesthesia alone for phacoemulsification cataract surgery in adults</title><source>Alma/SFX Local Collection</source><creator>Minakaran, Neda ; Ezra, Daniel G ; Allan, Bruce DS</creator><creatorcontrib>Minakaran, Neda ; Ezra, Daniel G ; Allan, Bruce DS</creatorcontrib><description>Local anaesthetics in cataract surgery: do eye drops work better with, or without, an injection of anaesthetic?
What are cataracts?
A cataract starts when cloudy patches develop on the lens of your eye. The lens is a small, clear disc inside the eye that focuses light rays to make clear images of objects seen. As the cloudy patches get bigger over time, sight becomes misty and blurred. Cataracts are more common in older people, and can affect your ability to do everyday activities, such as driving. Untreated cataracts will lead to blindness.
How are cataracts treated?
Surgery is the only way to improve your eyesight if you have cataracts. In cataract surgery (phacoemulsification), a tiny cut is made in your eye; the old, cloudy lens is removed and a new, plastic lens is put in its place.
During the operation you are usually awake. Doctors use eye drops containing a numbing medicine (local anaesthetic) to stop the nerves in your eye sending pain signals to your brain during the operation. Sometimes, in addition to anaesthetic eye drops, lidocaine (a type of local anaesthetic) may be injected inside your eye. This may reduce pain during and after the operation.
Why did we do this review?
In this Cochrane Review, we wanted to identify the potential benefits and harms of lidocaine injection into the eye in addition to anaesthetic eye drops during cataract surgery.
What did we do?
In February 2020, we searched for studies that looked at the effects of giving a lidocaine injection and anaesthetic eye drops, compared with giving anaesthetic eye drops alone, during cataract surgery. We looked for randomized controlled studies, a type of study in which treatments are given at random to people in the people in the study because these studies usually give the most reliable evidence about treatments.
Search date:
we included evidence published up to 4 February 2020.
What we found
We found 13 studies in 2355 adults, aged 34 to 95 years, who had cataract surgery in one or both eyes. The studies were conducted in hospitals and eye day‐care centres in the USA, Canada, Australia, the UK, Italy, Taiwan, Singapore, India, and Pakistan.
What are the results of the review?
Compared with giving anaesthetic eye drops alone, lidocaine injection with anaesthetic eye drops probably:
· reduced the level of pain experienced during the operation;
· reduced the number of people who said they felt any pain during their operation;
· did not reduce the level of pain people said they felt after the operation; and
· did not cause additional eye damage (measured before the operation and after 1 and 12 months).
Lidocaine injection with anaesthetic eye drops may make little or no difference to:
· how many people needed extra anaesthesia during their operation; and
· people's satisfaction with their cataract surgery (we are uncertain about this result because it is based on only one study).
The numbers of unwanted (adverse) effects associated with local anaesthetics were similar between people who had eye drops alone and those who had eye drops and a lidocaine injection. But we are uncertain about this result because the type of study we looked at may not have been the best to assess unwanted effects.
Our confidence in the results
We are moderately confident (certain) in most of our results. However, we only looked at a small number of studies, and in some studies the doctors were aware of which treatment they were giving, which could have affected the study's results. Our results may change if more research becomes available.
Conclusions
Lidocaine injection plus anaesthetic eye drops probably reduced the level of pain during a cataract operation more than using anaesthetic eye drops alone, and led to fewer people reporting pain during the operation. However, pain ratings for this operation were generally low both with and without a lidocaine injection, so this difference may not be clinically important.
Lidocaine injection plus anaesthetic eye drops did not reduce the level of pain people said they felt after their operation. Although lidocaine injection did not cause additional eye damage, we are uncertain whether its use causes more unwanted effects than eye drops alone.</description><identifier>EISSN: 1469-493X</identifier><identifier>DOI: 10.1002/14651858.CD005276.pub3</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Miscellaneous ; Pain & anaesthesia</subject><ispartof>Cochrane database of systematic reviews, 2020-08, Vol.2020 (7)</ispartof><rights>Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids></links><search><creatorcontrib>Minakaran, Neda</creatorcontrib><creatorcontrib>Ezra, Daniel G</creatorcontrib><creatorcontrib>Allan, Bruce DS</creatorcontrib><title>Topical anaesthesia plus intracameral lidocaine versus topical anaesthesia alone for phacoemulsification cataract surgery in adults</title><title>Cochrane database of systematic reviews</title><description>Local anaesthetics in cataract surgery: do eye drops work better with, or without, an injection of anaesthetic?
What are cataracts?
A cataract starts when cloudy patches develop on the lens of your eye. The lens is a small, clear disc inside the eye that focuses light rays to make clear images of objects seen. As the cloudy patches get bigger over time, sight becomes misty and blurred. Cataracts are more common in older people, and can affect your ability to do everyday activities, such as driving. Untreated cataracts will lead to blindness.
How are cataracts treated?
Surgery is the only way to improve your eyesight if you have cataracts. In cataract surgery (phacoemulsification), a tiny cut is made in your eye; the old, cloudy lens is removed and a new, plastic lens is put in its place.
During the operation you are usually awake. Doctors use eye drops containing a numbing medicine (local anaesthetic) to stop the nerves in your eye sending pain signals to your brain during the operation. Sometimes, in addition to anaesthetic eye drops, lidocaine (a type of local anaesthetic) may be injected inside your eye. This may reduce pain during and after the operation.
Why did we do this review?
In this Cochrane Review, we wanted to identify the potential benefits and harms of lidocaine injection into the eye in addition to anaesthetic eye drops during cataract surgery.
What did we do?
In February 2020, we searched for studies that looked at the effects of giving a lidocaine injection and anaesthetic eye drops, compared with giving anaesthetic eye drops alone, during cataract surgery. We looked for randomized controlled studies, a type of study in which treatments are given at random to people in the people in the study because these studies usually give the most reliable evidence about treatments.
Search date:
we included evidence published up to 4 February 2020.
What we found
We found 13 studies in 2355 adults, aged 34 to 95 years, who had cataract surgery in one or both eyes. The studies were conducted in hospitals and eye day‐care centres in the USA, Canada, Australia, the UK, Italy, Taiwan, Singapore, India, and Pakistan.
What are the results of the review?
Compared with giving anaesthetic eye drops alone, lidocaine injection with anaesthetic eye drops probably:
· reduced the level of pain experienced during the operation;
· reduced the number of people who said they felt any pain during their operation;
· did not reduce the level of pain people said they felt after the operation; and
· did not cause additional eye damage (measured before the operation and after 1 and 12 months).
Lidocaine injection with anaesthetic eye drops may make little or no difference to:
· how many people needed extra anaesthesia during their operation; and
· people's satisfaction with their cataract surgery (we are uncertain about this result because it is based on only one study).
The numbers of unwanted (adverse) effects associated with local anaesthetics were similar between people who had eye drops alone and those who had eye drops and a lidocaine injection. But we are uncertain about this result because the type of study we looked at may not have been the best to assess unwanted effects.
Our confidence in the results
We are moderately confident (certain) in most of our results. However, we only looked at a small number of studies, and in some studies the doctors were aware of which treatment they were giving, which could have affected the study's results. Our results may change if more research becomes available.
Conclusions
Lidocaine injection plus anaesthetic eye drops probably reduced the level of pain during a cataract operation more than using anaesthetic eye drops alone, and led to fewer people reporting pain during the operation. However, pain ratings for this operation were generally low both with and without a lidocaine injection, so this difference may not be clinically important.
Lidocaine injection plus anaesthetic eye drops did not reduce the level of pain people said they felt after their operation. Although lidocaine injection did not cause additional eye damage, we are uncertain whether its use causes more unwanted effects than eye drops alone.</description><subject>Miscellaneous</subject><subject>Pain & anaesthesia</subject><issn>1469-493X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNptkM1KxDAUhYMgOP68guQFOt40TZtsBBl_YcDNCO7KnTSZiaRNSdqBWfviRnQjuDqL79xzOJeQawZLBlDesKoWTAq5XN0DiLKpl-O85SdkkYEqKsXfz8h5Sh8AXDEmF-RzE0an0VMc0KRpb5JDOvo5UTdMETX2JmbqXRc0usHQg4kp0-mfM_QhG2yIdNyjDqaffXI22yYXBpoFc-BE0xx3Jh5zAcVu9lO6JKcWfTJXv3pB3h4fNqvnYv369LK6Wxe6bBQvmkZ3jcRaGBBs29VK6KZD4LW1ysquksoKzQVCtQUGFrGyrLYlNKo0UtiKX5Dbn9z8k9502nwv9O0YXY_x2AZ07V8yuH27C4dWVqDKGvgXkANxgw</recordid><startdate>20200801</startdate><enddate>20200801</enddate><creator>Minakaran, Neda</creator><creator>Ezra, Daniel G</creator><creator>Allan, Bruce DS</creator><general>John Wiley & Sons, Ltd</general><scope>5PM</scope></search><sort><creationdate>20200801</creationdate><title>Topical anaesthesia plus intracameral lidocaine versus topical anaesthesia alone for phacoemulsification cataract surgery in adults</title><author>Minakaran, Neda ; Ezra, Daniel G ; Allan, Bruce DS</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2793-77cd78a65e051bd695c7da036ff9f8d489f5c35a04b010faa4f16f20792e85f43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Miscellaneous</topic><topic>Pain & anaesthesia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Minakaran, Neda</creatorcontrib><creatorcontrib>Ezra, Daniel G</creatorcontrib><creatorcontrib>Allan, Bruce DS</creatorcontrib><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cochrane database of systematic reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Minakaran, Neda</au><au>Ezra, Daniel G</au><au>Allan, Bruce DS</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Topical anaesthesia plus intracameral lidocaine versus topical anaesthesia alone for phacoemulsification cataract surgery in adults</atitle><jtitle>Cochrane database of systematic reviews</jtitle><date>2020-08-01</date><risdate>2020</risdate><volume>2020</volume><issue>7</issue><eissn>1469-493X</eissn><abstract>Local anaesthetics in cataract surgery: do eye drops work better with, or without, an injection of anaesthetic?
What are cataracts?
A cataract starts when cloudy patches develop on the lens of your eye. The lens is a small, clear disc inside the eye that focuses light rays to make clear images of objects seen. As the cloudy patches get bigger over time, sight becomes misty and blurred. Cataracts are more common in older people, and can affect your ability to do everyday activities, such as driving. Untreated cataracts will lead to blindness.
How are cataracts treated?
Surgery is the only way to improve your eyesight if you have cataracts. In cataract surgery (phacoemulsification), a tiny cut is made in your eye; the old, cloudy lens is removed and a new, plastic lens is put in its place.
During the operation you are usually awake. Doctors use eye drops containing a numbing medicine (local anaesthetic) to stop the nerves in your eye sending pain signals to your brain during the operation. Sometimes, in addition to anaesthetic eye drops, lidocaine (a type of local anaesthetic) may be injected inside your eye. This may reduce pain during and after the operation.
Why did we do this review?
In this Cochrane Review, we wanted to identify the potential benefits and harms of lidocaine injection into the eye in addition to anaesthetic eye drops during cataract surgery.
What did we do?
In February 2020, we searched for studies that looked at the effects of giving a lidocaine injection and anaesthetic eye drops, compared with giving anaesthetic eye drops alone, during cataract surgery. We looked for randomized controlled studies, a type of study in which treatments are given at random to people in the people in the study because these studies usually give the most reliable evidence about treatments.
Search date:
we included evidence published up to 4 February 2020.
What we found
We found 13 studies in 2355 adults, aged 34 to 95 years, who had cataract surgery in one or both eyes. The studies were conducted in hospitals and eye day‐care centres in the USA, Canada, Australia, the UK, Italy, Taiwan, Singapore, India, and Pakistan.
What are the results of the review?
Compared with giving anaesthetic eye drops alone, lidocaine injection with anaesthetic eye drops probably:
· reduced the level of pain experienced during the operation;
· reduced the number of people who said they felt any pain during their operation;
· did not reduce the level of pain people said they felt after the operation; and
· did not cause additional eye damage (measured before the operation and after 1 and 12 months).
Lidocaine injection with anaesthetic eye drops may make little or no difference to:
· how many people needed extra anaesthesia during their operation; and
· people's satisfaction with their cataract surgery (we are uncertain about this result because it is based on only one study).
The numbers of unwanted (adverse) effects associated with local anaesthetics were similar between people who had eye drops alone and those who had eye drops and a lidocaine injection. But we are uncertain about this result because the type of study we looked at may not have been the best to assess unwanted effects.
Our confidence in the results
We are moderately confident (certain) in most of our results. However, we only looked at a small number of studies, and in some studies the doctors were aware of which treatment they were giving, which could have affected the study's results. Our results may change if more research becomes available.
Conclusions
Lidocaine injection plus anaesthetic eye drops probably reduced the level of pain during a cataract operation more than using anaesthetic eye drops alone, and led to fewer people reporting pain during the operation. However, pain ratings for this operation were generally low both with and without a lidocaine injection, so this difference may not be clinically important.
Lidocaine injection plus anaesthetic eye drops did not reduce the level of pain people said they felt after their operation. Although lidocaine injection did not cause additional eye damage, we are uncertain whether its use causes more unwanted effects than eye drops alone.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><doi>10.1002/14651858.CD005276.pub3</doi><oa>free_for_read</oa></addata></record> |
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| identifier | EISSN: 1469-493X |
| ispartof | Cochrane database of systematic reviews, 2020-08, Vol.2020 (7) |
| issn | 1469-493X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8409260 |
| source | Alma/SFX Local Collection |
| subjects | Miscellaneous Pain & anaesthesia |
| title | Topical anaesthesia plus intracameral lidocaine versus topical anaesthesia alone for phacoemulsification cataract surgery in adults |
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