Peribulbar anaesthesia controls intravitreal injection-related pain

Peribulbar anaesthesia is the most effective way to control injection-related pain resulting from intravitreal delivery of bevacizumab, according to a study published in the January/February issue of Clinical Science.

Ingrid U. Scott, MD, MPH, of the Department of Ophthalmology at Penn State College of Medicine, Pennsylvania, US and colleagues compared the analgesic effectiveness of anaesthesia when delivered topically (proxymetacaine eye drops), subconjunctivally (2% xylocaine) or to the peribulbar (2% xylocaine) to 60 patients undergoing their first bevacizumab injection. Fifteen minutes after the procedure, the team assessed the levels of pain associated with injection and the entire procedure, and 24 hours later the degree of subconjunctival haemorrhage was also assessed.

Patients receiving peribulbar anaesthesia had a lower median pain-score related to injection than either of the other two groups, although the median pain-score related to the entire procedure was highest in this group. There was no significant difference in pain scores between the topical and the subconjunctival groups. The lowest median degree of subconjunctival haemorrhage was recorded in the topical anaesthesia group.

Thus the researchers concluded that peribulbar anaesthesia application is associated with the lowest level of injection-related pain, and topical eye drop anaesthesia is associated with the lowest extent of subconjunctival haemorrhage.