The effect of two local anaesthetic techniques on pain scores during and after intravitreal injection

Subcutaneous injection of 0.2mL of 2% lignocaine (SCI) was compared with topical pledget 0.5% amethocaine hydrochloride (TP) for peri procedural pain during intravitreal injections of anti VEGF agents. Patients received injections of bevacizumab (Avastin; Roche Australia, Dee Why, NSW), ranibizumab (Lucentis; Novartis, North Ryde, NSW) or aflibercept (Eylea; Bayer AG, Pymble, NSW) depending on the choice of their treating ophthalmologist for a variety of conditions. All patients received 2 drops of 0.5% amethocaine hydrochloride spaced 1 minute apart, which were allowed to work for 2 minutes before progressing. In the SCI group, 0.2mL of 2% lignocaine was injected as a bleb in the superior-temporal region, followed by sterile preparation, then administration of the anti VGEF injection. In the TP group, following sterile preparation, a cotton bud soaked in 0.5% amethocaine hydrochloride was applied to the superior-temporal region for 30 seconds followed immediately by the anti-VEGF injection. Sterile preparation in both groups involved instillation of 1 drop of half strength 5% Povidone-iodine and positioning of an eyelid speculum. In the first part of the trial, each participant received only one of the interventions (either SCI or TP local anaesthetic technique). In the second part of the trial, 67 out of the original 112 participants returned and received the opposite local anaesthetic technique for their next anti VGEF treatment. Duration between treatments were 4-6 weeks. Interventions were administered to one eye only.