Comparing the Effects of Lidocaine/Paracetamol and Midazolam/Fentanyl as a Premedication on Pain Intensity and Hemodynamic Changes in Patients Undergoing Cataract Surgery With Topical Anesthesia: A Randomized Double-blinded Pilot Study

authors:

avatar nasim zarrin 1 , avatar marzieh khezri 2 , * , avatar Rahele Safaie 3 , avatar Mohammadreza Oladi 4

Department of Anesthesiology, Clinical Research Development Unit, Kosar Hospital, Qazvin University of Medical Sciences, Qazvin, Iran..
Department of Anesthesiology, Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
Department of Anesthesiology, Clinical Research Development Unit, Kosar Hospital. Qazvin University of Medical Sciences, Qazvin, Iran.
Department of Ophthalmology, School of Medicine Science, Qazvin University of Medical Sciences, Qazvin, Iran.
Journal of Inflammatory Diseases: Vol.26, issue 2; 79-88
article type: issue_documents_importer

how to cite: zarrin N, khezri M, Safaie R, Oladi M . Comparing the Effects of Lidocaine/Paracetamol and Midazolam/Fentanyl as a Premedication on Pain Intensity and Hemodynamic Changes in Patients Undergoing Cataract Surgery With Topical Anesthesia: A Randomized Double-blinded Pilot Study. J Inflamm Dis. 2022;26(2):e156312. 

Abstract

 Background: Several supplementary approaches have been used to increase the patient’s comfort during phacoemulsification under topical anesthesia. Objective: This study aimed to compare the effects of lidocaine/paracetamol (LP) and midazolam/fentanyl (MF) administration on pain intensity and hemodynamic changes in patients undergoing cataract surgery using phacoemulsification.  Methods: This study was designed and implemented as a pilot randomized double-blinded clinical trial. A total number of 80 patients with cataracts scheduled for phacoemulsification were randomly assigned to two groups (40 subjects in each group) to receive lidocaine at a dose of 1.5 mg/kg and then infused with 1 g of paracetamol in 100 cc of normal saline (LP group) or midazolam 0.2 mg/kg and fentanyl 1.5 µg/kg (MF group). Hemodynamic parameters and sedation scores were measured before, 5, and 15 minutes after surgery, and then during recovery. Furthermore, pain (VAS), patient-surgeon satisfaction, propofol, and opioid consumption were all assessed. Findings: The sedation scores during recovery in the LP group were significantly lower (P= 0.04) than those in the MF group. Respiratory depression was also significantly lower (P<0.001) in the LP group compared to that infused by MF. According to other findings, no significant difference was observed between both study groups. Conclusion: The use of lidocaine-paracetamol as a supplementary approach for patients undergoing cataract surgery under topical anesthesia can cause better sedation scores with lower respiratory depression compared to the use of midazolam-fentanyl.