Pain perception in sequential cataract surgery: Comparison of first and second procedures

Purpose: To compare pain and anxiety between first and second cataract extractions under topical anesthesia with monitored anesthesia care. Setting: University ophthalmology clinic. Design: Cohort study. Methods: Consecutive adults having bilateral sequential clear corneal cataract extraction using phacoemulsification under topical anesthesia with monitored anesthesia care were recruited. Exclusion criteria included baseline eye pain, poor comprehension, and complicated cataract extraction. Patients completed 4 short perioperative surveys with each cataract extraction as follows: the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the State-Trait Anxiety Scale (STAI) preoperatively and a 0-to-10 visual analog scale pain survey twice after surgery. Pain and difference in pain were the primary outcomes. Results: Of the 65 patients who completed the study, 26 (40%) reported higher visual analog scale pain scores for the second cataract extraction. Overall, the median pain score was 0 (range 0 to 6) for the first cataract extraction and 1 (range 0 to 9) for the second (P=.004). By 1 day postoperatively, the pain scores were similar (median 0; range 0 to 9; P=.58). Both APAIS and STAI anxiety scores decreased between surgeries (P=.003 and P<.001, respectively). Conclusions: Although cataract extraction remained relatively painless under topical anesthesia with monitored anesthesia care, there was a subtle increase in pain in the second surgery relative to the first. This appears to be associated with decreased preoperative anxiety and may be related to the amnestic effects of intravenous sedation. These data may explain a common operative observation. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.