Predictors of pain during phacoemulsification under local sedation: A multicentric study.

Purpose: To assess the risk factors for pain during cataract surgery under local anesthesia.

Methods: This multicentric observational study assessed risk factors for pain during cataract surgery from June to November 2020 in a private clinic and two university hospitals (France). Adults who underwent cataract surgery under local anesthesia with conscious sedation were consecutively included. Exclusion criteria were locoregional anesthesia and an inability to communicate. Once the surgical drape was removed, patients rated the pain on a numerical rating scale (NRS) from 0 to 10, after the surgical drape was removed. Clinical and biometric parameter data were retrieved from medical records. Multivariate logistic regression was used to determine factors associated with pain during cataract surgery.

Results: Among the 387 eyes (330 patients), 53 (13.7%) were classified by patients as painful (numerical rating scale [NRS] score≥4). An intraoperative painful eye (NRS score≥4) was associated with intraocular lens (IOL) power<19 D (OR=2.78, P=0.005), chronic analgesic use (OR=4.34, P=0.011), and brown or white type of cataract (OR=5.68, P=0.008).

Conclusion: In conclusion, anesthesia should be adapted for myopic eyes with IOL power<19 D, chronic analgesic use, and brown or white cataract. A larger study may help develop a predictive score for pain that could, for example, be integrated into a biometer.