Local Anesthetics in Diabetic Retinopathy Procedures: A Comprehensive Review With a Focus on Lidocaine-Based Pain Control

Abstract

This review investigates commonly used local anesthetic agents and administration methods in diabetic retinopathy (DR) procedures, such as pan-retinal photocoagulation, intravitreal injections, and vitrectomy, focusing on pain control and procedural outcomes. A systematic review of PubMed was conducted to identify studies examining local anesthetic use in DR procedures. Studies were screened for relevance, full-text availability, and methodological rigor. Fourteen studies met the inclusion criteria and were evaluated for anesthetic type, dosage, application route, co-administration, and patient outcome. The Joanna Briggs Institute (JBI) critical appraisal tools were used to evaluate the methodological quality and risk of bias for each included study. Lidocaine emerged as the most frequently used anesthetic, effectively reducing pain and systolic pressure during pan-retinal photocoagulation and posterior vitrectomy. There was a statistically significant difference in the dosage of lidocaine (2.33 ± 1.00%) vs other alternative anesthetics (0.475 ± 0.05%) for surgical procedures used to treat DR. The topical application of lidocaine was preferred for its ease of administration and reduced risk of complications. Furthermore, povidone, an antiseptic agent, was frequently co-administered to disinfect the ocular surface and maintain aseptic conditions during intravitreal injections, reducing the risk of infection. Among the local anesthetics reviewed, lidocaine, administered topically or via injection, was most frequently studied and demonstrated effective procedural analgesia and favorable post-surgical outcomes. These findings suggest lidocaine is a suitable choice for DR procedures. Exploration of lidocaine's impact, consideration of patient medical history, and examination of a broader range of co-administered drugs are recommended for comprehensive insights into optimizing patient outcomes.

Keywords: anesthesia; diabetic retinopathy; lidocaine; pain management; panretinal photocoagulation; surgical outcomes.

Figure 1. PRISMA flow diagram illustrating the selection of studies for the review on anesthesia use in diabetic retinopathy surgery.

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses