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Table 2 Pain in the included studies according to Jensen’s classification [8]

From: Patient pain during intravitreal injections under topical anesthesia: a systematic review

References (country) Groups according to anesthetic method Difference in pain Mean pain score related to discomfort of anesthesia Mean pain score during injection Mean global pain Jensen’s classification
Blaha et al. [16] (USA) G1: 0.5% topical proparacaine NS G1: 14 G1: 30 G1: 44 G1: MI
G2: 0.5% topical tetracaine G2: 7 G2: 28 G2: 35 G2: MI
G3: topical proparacaine + 4% lidocaine pledget G3: 16 G3: 23 G3: 39 G3: MI
G4: topical proparacaine + SC injection of 2% lidocaine G4: 10
p = 0.17 (NS)
G4: 31
p = 0.28 (NS)
G4: 41
p = 0.65 (NS)
G4: MI
Yau et al. [11] (Canada) G1: 0.5% tetracaine hydrochloride drops + 4% lidocaine pledget for 10 NS NA G1: 19 NA G1: MI
G2: 0.5% tetracaine hydrochloride drops G2: 21 G2: MI
G3: 4% cocaine + epinephrine 1/100.000 drops G3: 21 G3: MI
Örnek et al. [14] (Turkey) G1: 0.75% levobupivacaine drops Statistically different, but not clinically significant NA G1: 44.77 NA G1: MI
  G2: 0.5% proparacaine drops G2: 34.18
p = 0.003
  G2: MI
Shiroma et al. [1] (Brazil) G1: 2% lidocaine gel NS G1: 0 G1: 26.3 ± 16.8 G1: 26.3 G1: MI
G2: 3.5% lidocaine gel G2: 0 G2: 20.8 ± 13.5 G2: 20.8 G2: MI
G3: 5% lidocaine gel G3: 0 G3: 20.0 ± 16.5 G3: 20.0 G3: MI
G4: 8% lidocaine gel G4: 0 G4: 19.3 ± 14.0 G4: 19.3 G4: MI
G5: 12% lidocaine gel G5: 0 G5: 18.3 ± 13.5 G5: 18.3 G5: MI
Andrade et al. [6] (Brazil) G1: proparacaine SC injection of 2% lidocaine was most effective, with clinical significance (>12 mm) NA G1: 32 ± 17 NA G1: MI
G2: proparacaine + SC injection of 2% lidocaine G2: 10 ± 10 G2: MI
G3: 2% lidocaine gel G3: 10 ± 11
p = 0.02
G3: MI
Kumar et al. [15] (UK) G1: 0.5% proximetacaine NS G1: 6.0 ± 0.63 G1: 8.7 ± 0.83 G1: 14.7 G1: MI
G2: SC injection of 2% lidocaine G2: 6.0 ± 0.96 G2: 9.3 ± 0.96
p = 0.84
G2: 15.3 G2: MI
Davis et al. [2] (USA) GA: 0.5% topical proparacaine NS NA G1: 17.8 ± 14.4 NA G1: MI
GB: topical proparacaine + 4% lidocaine pledget G2: 17.5 ± 14.6 G2: MI
GC: 3.5% lidocaine gel G3: 14.8 ± 15.8
p = 0.38
G3: MI
Rifkin and Schaal [5] (USA) G1: 0.5% TetraVisc Statistically different, but not clinically significant NA G1: 33.9 ± 22.6 NA G1: MI
G2: proparacaine G2: 31.7 ± 21.8 G2: MI
G3: tetracaine G3: 30.5 ± 20.1
p < 0.01
G3: MI
  1. G group, MI mild, S significant, NS not significant, NA not available