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Some patients may report increased pain for second cataract extraction
J Cataract Refract Surg.2011;37(6):1009-1014.
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A subtle increase in pain during a patient's second cataract extraction relative to the first may be associated with decreased preoperative anxiety, a study found.
"Having enjoyed a successful first cataract extraction, a portion of patients may subsequently approach their second cataract extraction with less trepidation but also an expectation of less pain. Any pain they experience is then perceived as significant," the study authors wrote.
The prospective, single-masked, longitudinal trial included 65 patients who underwent bilateral cataract surgery and completed the Amsterdam Preoperative Anxiety and Information Scale, the preoperatively administered State-Trait Anxiety Scale and two visual analogue scale pain surveys administered twice postoperatively.
The median visual analogue pain score for the first cataract surgery was 0 on a scale of 0 to 10. The median score for the second extraction was 1, with 40% of patients reporting higher scores for their second operation. This difference was no longer evident by postoperative day 1.
An increase in reported pain was associated with a lower level of preoperative anxiety prior to the second procedure.
"We recommend preoperative counseling for all patients before their second cataract extraction, cautioning that the more relaxed they are this time, the more unexpected and heightened any pain may feel," the study authors wrote.
Lower levels of anxiety may be explained by the amnestic effects of benzodiazepines during the first surgery, which may cause patients to present to the second operation with expectations of heavy sedation, the study authors said.