Clinical Study of Acupuncture Combined with Surface Anesthesia Using Proparacaine in Geriatric Cataract Phacoemulsification

Overview

Journal World J Clin Cases

Publisher Baishideng Publishing Group

Specialty General Medicine

Date 2023 Aug 16

PMID 37583853

Authors

Ping Dong

Li-Fang Wang

Li-Xiang Zhang

Fang Li

Hui-Su Yin

Zhi-Xia Dou

Xiu-Ju Huang

Rui Xu

Wu-Lin Zhang

Affiliations

Soon will be listed here.

Abstract

Background: During anesthesia administration for cataract surgery, low pH of proparacaine may induce pain or complications such as corneal damage and poor wound healing, with the use of additional drops intraoperatively increasing the risk of complications. Accordingly, there is a clinical need for adjuncts to local anesthesia needs to improve the efficiency of anesthesia and reduce the required amount of intraoperative proparacaine.

Aim: To identify a method of anesthesia for geriatric cataract phacoemulsification that provides more efficient analgesia and improves clinical efficacy.

Methods: A total of 130 geriatric patients with cataracts who attended Hebei Eye Hospital from December 2020 to December 2022 were included in the present study. Patients were divided into the proparacaine surface anesthesia (SA) group (65 cases) and the compound acupuncture-medicine anesthesia group (CAMA group, 65 cases). Patients in the CAMA group were provided acupuncture analgesia in addition to SA. Preoperative anxiety [Self-Rating Anxiety Scale (SAS) score and state anxiety inventory (SAI) score], intraoperative stress, vital signs, analgesia, and cooperation, as well as postoperative adverse events, were compared between groups.

Results: More marked reductions in anxiety were observed among patients in the CAMA group, with corresponding reductions in SAS and SAI scores. During the operation, no change in the secretion of E, NE, or Cor group compared to the preoperative period was observed in the CAMA, which was markedly lower than that in the SA group. Heart rate, blood pressure, and respiratory rate were more stable intraoperatively in the CAMA group. In addition, the incidence of intraoperative pain and the number of additional doses of anesthesia required in the CAMA group were markedly lower than in the SA group. Accordingly, patients in the CAMA group were able to avoid eye movements and eyelid closing leading to greater cooperation with surgeons during surgery. Furthermore, marked reductions in intraoperative adverse effects were observed in the CAMA group, indicating greater overall safety.

Conclusion: Proparacaine SA combined with acupuncture as an analgesic provides improved analgesia with greater safety compared to surface anesthesia with proparacaine during geriatric cataract phacoemulsification.

Citing Articles

Based on the relationship between anxiety of existential meaninglessness, hope level, and fear of progression, explored the effect of preoperative nursing with Orem theory in the senile cataract population.

Zhang Y, Cheng Y, Liang Y, Shao M, Chen A Front Psychol. 2024; 15:1358229.

PMID: 38800682 PMC: 11117140. DOI: 10.3389/fpsyg.2024.1358229.

References

Qureshi M, Steel D . Retinal detachment following cataract phacoemulsification-a review of the literature. Eye (Lond). 2019; 34(4):616-631. PMC: 7093479. DOI: 10.1038/s41433-019-0575-z. View

Cheng L, Li P, Tjen-A-Looi S, Longhurst J . What do we understand from clinical and mechanistic studies on acupuncture treatment for hypertension?. Chin Med. 2015; 10:36. PMC: 4666174. DOI: 10.1186/s13020-015-0070-9. View

Gioia L, Cabrini L, Gemma M, Fiori R, Fasce F, Bolognesi G . Sedative effect of acupuncture during cataract surgery: prospective randomized double-blind study. J Cataract Refract Surg. 2006; 32(11):1951-4. DOI: 10.1016/j.jcrs.2006.06.027. View

Ma W, Zhu Y, Zhou H, Fu G, Pan H, Shen W . [Protecting action of acupuncture-drug compound anesthesia with different frequency electroacupuncture on stress reaction in pneumonectomy]. Zhongguo Zhen Jiu. 2011; 31(11):1020-4. View

Kongsap P . Superior subconjunctival anesthesia versus retrobulbar anesthesia for manual small-incision cataract surgery in a residency training program: a randomized controlled trial. Clin Ophthalmol. 2012; 6:1981-6. PMC: 3516495. DOI: 10.2147/OPTH.S38606. View

Joshi R . Proparacaine hydrochloride topical drop and intracameral 0.5% lignocaine for phacotrabeculectomy in patients with primary open angle glaucoma. Middle East Afr J Ophthalmol. 2014; 21(3):210-5. PMC: 4123271. DOI: 10.4103/0974-9233.134669. View

Liu Y, Park J, Shin K, Lee M, Jung H, Kim A . Acupuncture lowers blood pressure in mild hypertension patients: a randomized, controlled, assessor-blinded pilot trial. Complement Ther Med. 2015; 23(5):658-65. DOI: 10.1016/j.ctim.2015.06.014. View

Ryu J, Kim M, Bahk J, Do S, Cheong I, Kim Y . A comparison of retrobulbar block, sub-Tenon block, and topical anesthesia during cataract surgery. Eur J Ophthalmol. 2009; 19(2):240-6. DOI: 10.1177/112067210901900211. View

Solano M, Lin S . Cataract, phacoemulsification and intraocular pressure: Is the anterior segment anatomy the missing piece of the puzzle?. Prog Retin Eye Res. 2018; 64:77-83. DOI: 10.1016/j.preteyeres.2018.01.003. View

10.

Ji S, Zhang H, Qin W, Liu M, Zheng W, Han Y . Effect of Acupuncture Stimulation of Hegu (LI4) and Taichong (LR3) on the Resting-State Networks in Alzheimer's Disease: Beyond the Default Mode Network. Neural Plast. 2021; 2021:8876873. PMC: 7960059. DOI: 10.1155/2021/8876873. View

11.

Shimoyama M, Toyama S, Tagaito Y, Shimoyama N . Endogenous endomorphin-2 contributes to spinal ĸ-opioid antinociception. Pharmacology. 2012; 89(3-4):145-8. DOI: 10.1159/000336770. View

12.

Jiang M, Liang J, Zhang Y, Wang J, Hao J, Wang M . [Effects of Acupuncture Stimulation of Bilateral "Hegu" (LI 4) and "Taichong" (LR 3) on Learning-memory Ability, Hippocampal AP 42 Expression and Inflammatory Cytokines in Rats with Alzheimer's Disease]. Zhen Ci Yan Jiu. 2016; 41(2):113-8. View

13.

Little W, Jean G, Sithole F, Little E, Jean K . Degree of corneal anaesthesia after topical application of 0.4% oxybuprocaine hydrochloride and 0.5% proparacaine hydrochloride ophthalmic solution in clinically normal cattle. Aust Vet J. 2016; 94(6):181-5. DOI: 10.1111/avj.12443. View

14.

Goldman N, Chen M, Fujita T, Xu Q, Peng W, Liu W . Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nat Neurosci. 2010; 13(7):883-8. PMC: 3467968. DOI: 10.1038/nn.2562. View

15.

Zhiyuan W, Ming Y, Jie J, Yi W, Tiansheng H, Mingfen L . Effect of transcutaneous electrical nerve stimulation at acupoints on patients with type 2 diabetes mellitus: a randomized controlled trial. J Tradit Chin Med. 2015; 35(2):134-40. DOI: 10.1016/s0254-6272(15)30020-0. View

16.

Day A, Gore D, Bunce C, Evans J . Laser-assisted cataract surgery versus standard ultrasound phacoemulsification cataract surgery. Cochrane Database Syst Rev. 2016; 7:CD010735. PMC: 6458014. DOI: 10.1002/14651858.CD010735.pub2. View

17.

Yang Z, Zhao J, Feng Y, Lei Y, Liu D, Qin F . Identification, synthesis and structural confirmation of process-related impurities in proparacaine hydrochloride. J Pharm Biomed Anal. 2020; 190:113497. DOI: 10.1016/j.jpba.2020.113497. View

18.

Nagy A, El-Sayd S, Ahmed A, Rajab G . Optimal Dose of Dexmedetomidine Retrobulbar Anesthesia during Phacoemulsification Cataract Surgery. Anesth Essays Res. 2017; 11(4):1046-1050. PMC: 5735448. DOI: 10.4103/aer.AER_116_17. View

19.

Pirogova E, Fabrikantov O, Nikolashin S . [Femtolaser-assisted phacoemulsification of intumescent cataract]. Vestn Oftalmol. 2022; 138(1):13-22. DOI: 10.17116/oftalma202213801113. View

20.

Zhao Z . Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008; 85(4):355-75. DOI: 10.1016/j.pneurobio.2008.05.004. View