Predictors of pain during phacoemulsification under local sedation: A multicentric study

E Debourdeau; F Ortis; C Chamard; H Crowdy; L Jeanjean; D Audemard; A Payerols; M Villain; A De Jong; V Daien

doi:10.1016/j.jfo.2024.104346

Predictors of pain during phacoemulsification under local sedation: A multicentric study

J Fr Ophtalmol. 2024 Oct 29;48(1):104346. doi: 10.1016/j.jfo.2024.104346. Online ahead of print.

Authors

E Debourdeau¹, F Ortis², C Chamard³, H Crowdy², L Jeanjean⁴, D Audemard⁴, A Payerols⁵, M Villain², A De Jong⁶, V Daien⁷

Affiliations

¹ Department of Ophthalmology, Gui-de-Chauliac Hospital, 80, avenue Augustin-Fliche, 34000 Montpellier, France; Institute for Neurosciences of Montpellier INM, University Montpellier, Inserm, 34091 Montpellier, France. Electronic address: [email protected].
² Department of Ophthalmology, Gui-de-Chauliac Hospital, 80, avenue Augustin-Fliche, 34000 Montpellier, France.
³ Department of Ophthalmology, Gui-de-Chauliac Hospital, 80, avenue Augustin-Fliche, 34000 Montpellier, France; Institute for Neurosciences of Montpellier INM, University Montpellier, Inserm, 34091 Montpellier, France.
⁴ Department of ophthalmology, Caremeau Hospital, 30000 Nîmes, France.
⁵ Department of ophthalmology, Champeau Clinic, 34500 Beziers, France.
⁶ Research Unit: PhyMedExp, Inserm U-1046, CNRS, Anesthesia and Critical Care Department (DAR-B), Saint Eloi, University of Montpellier, 34295 Montpellier, France.
⁷ Department of Ophthalmology, Gui-de-Chauliac Hospital, 80, avenue Augustin-Fliche, 34000 Montpellier, France; Institute for Neurosciences of Montpellier INM, University Montpellier, Inserm, 34091 Montpellier, France; The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. Electronic address: [email protected].

PMID: 39476448
DOI: 10.1016/j.jfo.2024.104346

Abstract

Purpose: To assess the risk factors for pain during cataract surgery under local anesthesia.

Methods: This multicentric observational study assessed risk factors for pain during cataract surgery from June to November 2020 in a private clinic and two university hospitals (France). Adults who underwent cataract surgery under local anesthesia with conscious sedation were consecutively included. Exclusion criteria were locoregional anesthesia and an inability to communicate. Once the surgical drape was removed, patients rated the pain on a numerical rating scale (NRS) from 0 to 10, after the surgical drape was removed. Clinical and biometric parameter data were retrieved from medical records. Multivariate logistic regression was used to determine factors associated with pain during cataract surgery.

Results: Among the 387 eyes (330 patients), 53 (13.7%) were classified by patients as painful (numerical rating scale [NRS] score≥4). An intraoperative painful eye (NRS score≥4) was associated with intraocular lens (IOL) power<19 D (OR=2.78, P=0.005), chronic analgesic use (OR=4.34, P=0.011), and brown or white type of cataract (OR=5.68, P=0.008).

Conclusion: In conclusion, anesthesia should be adapted for myopic eyes with IOL power<19 D, chronic analgesic use, and brown or white cataract. A larger study may help develop a predictive score for pain that could, for example, be integrated into a biometer.

Keywords: Anesthésie ophtalmologique; Cataract surgery; Chirurgie de la cataracte; Douleur peropératoire; Douleur postopératoire; Intraoperative pain; Ophthalmologic anesthesia; Pain management; Postoperative pain; Prise en charge de la douleur.