Effect of Systemic Narcotics Added to Local Anesthetic Mixtures on Pain Experience and Patients Cooperation During Training Residents’ Phacoemulsification
Evaluation of the effect of different concentrations of fentanyl added to the local anesthetic mixture on pain expression and patients’ cooperation during phacoemulsification by training residents.
Setting:Kasr Al Aini hospital, Cairo University, Egypt. Design: Double blinded randomized controlled clinical trial. Methods: 60 patients with cataract scheduled for elective phacoemulsification under regional anesthesia. Randomly divided into, Group 1 (Control), patients received Lidocaine 2% and Hyaluronidase 15 IU/ml. In Groups 2, 3 and 4 (Fentanyl Groups), the patients received Lidocaine 2% and Hyaluronidase 15 IU/ml in addition to Fentanyl 1 μg/ml, 2 μg/ml and 3μg/ml respectively.Every patient was graded using a visual analogue scale (VAS) from 0 (no pain) to 10 (unbearable pain) after the surgery. The cooperation of the patient was graded from 0 (no event) to 3 (marked lids and eye squeezing) by the surgeon.
no statistically significant difference between the four groups in the onset and duration of lid and globe akinesia. There was a significant difference between the control group and the fentanyl groups as regard the duration of analgesia. In the control group and fentanyl 1μg/ml group, the patients’ analgesia lasts for 100-103 minutes from the local anesthetic injection, while it lasts for 116±19 minutes and 144±11 minutes in the fentanyl 2μg/ml group, and 3μg/ml group, respectively.
Local peribulbar Fentanyl injection in combination with Lidocaine and Hyaluronidase is a safe and effective method in prolonging analgesia and improving patients cooperation during lengthy phacoemulsification done by training residents.