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Pain during external dacryocystorhinostomy with local anesthesia.

Knežević MM, Stojković MŽ, Vlajković GP, Jovanović MB, Rašić DM - Med. Sci. Monit. (2011)

Bottom Line: Each patient was asked 30 minutes after surgery to indicate the intensity of pain experienced at each stage of the surgery and during intramuscular (i.m.) injection of an antibiotic using a visual analog scale (VAS).Analysis of the VAS-based pain scores indicated 3 statistically equal occurrences of pain coinciding with the opening of the ostium, and receiving both parabulbar anesthetic and i.m. antibiotic injections.The level of pain experienced during the most unpleasant stage of external DCR (ostium opening) was similar to the pain experienced from an i.m. injection.

View Article: PubMed Central - PubMed

Affiliation: University Eye Clinic, Clinical Center of Serbia, Belgrade, Serbia. knelemik@gmail.com

ABSTRACT

Background: External dacryocystorhinostomy (DCR) is often performed under local anesthesia (LA) without adequate knowledge of the pain experienced by the patient.

Material/methods: We subdivided our surgical technique into stages easily understood by the patients (introducing cotton tipped applicators, performing parabulbar injection, creating the incision, bone cracking (opening the ostium), manipulating the nose, intubating, closing the wound, and packing with gauze). A total of 50 patients ranging in age from 31 to 83 years of age (63.64±9.64) underwent external DCR. Each patient was asked 30 minutes after surgery to indicate the intensity of pain experienced at each stage of the surgery and during intramuscular (i.m.) injection of an antibiotic using a visual analog scale (VAS).

Results: Analysis of the VAS-based pain scores indicated 3 statistically equal occurrences of pain coinciding with the opening of the ostium, and receiving both parabulbar anesthetic and i.m. antibiotic injections.

Conclusions: The level of pain experienced during the most unpleasant stage of external DCR (ostium opening) was similar to the pain experienced from an i.m. injection. Patients can be informed that pain during external DCR with local anesthesia is comparable to receiving an i.m. gluteal injection.

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Pain levels in our series (numbers 1 to 10 represent stages of surgery). 1 – IM injection; 2 – introducing cotton tipped applicators; 3 – injection; 4 – incision (beginning of the procedure); 5 – bone cracking (ostium opening); 6 – nasal manipulation after bone cracking; 7 – intubation; 8 – wound closure; 9 – gauze packing; 10 – overall pain during procedure.
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f1-medscimonit-17-6-cr341: Pain levels in our series (numbers 1 to 10 represent stages of surgery). 1 – IM injection; 2 – introducing cotton tipped applicators; 3 – injection; 4 – incision (beginning of the procedure); 5 – bone cracking (ostium opening); 6 – nasal manipulation after bone cracking; 7 – intubation; 8 – wound closure; 9 – gauze packing; 10 – overall pain during procedure.

Mentions: Pain recorded at all stages of DCR was minor (Figure 1). Among these minor pain values, the lowest VAS pain level (median, 1) was present at multiple times: 1) at the introduction of the cotton tipped applicators; 2) at the beginning of the surgical procedure (skin incision and dissection of the lacrimal sac); 3) during nasal manipulation after bone cracking (incision and suture of nasal mucosa); 4) during intubation; 5) during wound closure; and 6) during nasal packing at the end of the procedure. Medium levels of pain (median, 2) were noted during the IM gluteal injection of prophylactic antibiotic, the LA injection, and the ostium opening, and for overall pain (Table 2). No statistically significant differences in pain levels between IM gluteal injection, LA injection, and ostium opening were observed (P>0.05).


Pain during external dacryocystorhinostomy with local anesthesia.

Knežević MM, Stojković MŽ, Vlajković GP, Jovanović MB, Rašić DM - Med. Sci. Monit. (2011)

Pain levels in our series (numbers 1 to 10 represent stages of surgery). 1 – IM injection; 2 – introducing cotton tipped applicators; 3 – injection; 4 – incision (beginning of the procedure); 5 – bone cracking (ostium opening); 6 – nasal manipulation after bone cracking; 7 – intubation; 8 – wound closure; 9 – gauze packing; 10 – overall pain during procedure.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539535&req=5

f1-medscimonit-17-6-cr341: Pain levels in our series (numbers 1 to 10 represent stages of surgery). 1 – IM injection; 2 – introducing cotton tipped applicators; 3 – injection; 4 – incision (beginning of the procedure); 5 – bone cracking (ostium opening); 6 – nasal manipulation after bone cracking; 7 – intubation; 8 – wound closure; 9 – gauze packing; 10 – overall pain during procedure.
Mentions: Pain recorded at all stages of DCR was minor (Figure 1). Among these minor pain values, the lowest VAS pain level (median, 1) was present at multiple times: 1) at the introduction of the cotton tipped applicators; 2) at the beginning of the surgical procedure (skin incision and dissection of the lacrimal sac); 3) during nasal manipulation after bone cracking (incision and suture of nasal mucosa); 4) during intubation; 5) during wound closure; and 6) during nasal packing at the end of the procedure. Medium levels of pain (median, 2) were noted during the IM gluteal injection of prophylactic antibiotic, the LA injection, and the ostium opening, and for overall pain (Table 2). No statistically significant differences in pain levels between IM gluteal injection, LA injection, and ostium opening were observed (P>0.05).

Bottom Line: Each patient was asked 30 minutes after surgery to indicate the intensity of pain experienced at each stage of the surgery and during intramuscular (i.m.) injection of an antibiotic using a visual analog scale (VAS).Analysis of the VAS-based pain scores indicated 3 statistically equal occurrences of pain coinciding with the opening of the ostium, and receiving both parabulbar anesthetic and i.m. antibiotic injections.The level of pain experienced during the most unpleasant stage of external DCR (ostium opening) was similar to the pain experienced from an i.m. injection.

View Article: PubMed Central - PubMed

Affiliation: University Eye Clinic, Clinical Center of Serbia, Belgrade, Serbia. knelemik@gmail.com

ABSTRACT

Background: External dacryocystorhinostomy (DCR) is often performed under local anesthesia (LA) without adequate knowledge of the pain experienced by the patient.

Material/methods: We subdivided our surgical technique into stages easily understood by the patients (introducing cotton tipped applicators, performing parabulbar injection, creating the incision, bone cracking (opening the ostium), manipulating the nose, intubating, closing the wound, and packing with gauze). A total of 50 patients ranging in age from 31 to 83 years of age (63.64±9.64) underwent external DCR. Each patient was asked 30 minutes after surgery to indicate the intensity of pain experienced at each stage of the surgery and during intramuscular (i.m.) injection of an antibiotic using a visual analog scale (VAS).

Results: Analysis of the VAS-based pain scores indicated 3 statistically equal occurrences of pain coinciding with the opening of the ostium, and receiving both parabulbar anesthetic and i.m. antibiotic injections.

Conclusions: The level of pain experienced during the most unpleasant stage of external DCR (ostium opening) was similar to the pain experienced from an i.m. injection. Patients can be informed that pain during external DCR with local anesthesia is comparable to receiving an i.m. gluteal injection.

Show MeSH
Related in: MedlinePlus