Efficacy of Mid-Procedure Lidocaine in Reducing Pain from Intracameral Moxifloxacin Injection During Cataract Surgery

Efficacy of Mid-Procedure Lidocaine in Reducing Pain from Intracameral Moxifloxacin Injection During Cataract Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Efficacy of Mid-Procedure Lidocaine in Reducing Pain from Intracameral Moxifloxacin Injection During Cataract Surgery Mimi Giang, M.D., Mitra Nejad, M.D., Tyler Kuk, Shawn R. Lin, M.D., MBA This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8554780/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Intracameral moxifloxacin administered at the conclusion of cataract surgery reduces postoperative drop burden and infection risk but may cause injection-related discomfort, potentially affecting patient safety and satisfaction. This study evaluated whether an additional mid-procedure dose of intracameral lidocaine could reduce pain associated with moxifloxacin injection. Methods This prospective interventional study included 50 cataract surgery patients under monitored anesthesia care. The interventional group (n=25) received an additional intracameral dose of 1% preservative-free lidocaine during instrument exchange, while the control group (n=25) did not. All patients then received intracameral moxifloxacin at the end of surgery, reporting verbal 0-10 pain scores before and after injection. Pain-delta scores, representing pain responses to moxifloxacin, were compared between the two groups. Patient age, sex, midazolam dosage administered prior to surgery, pre-operative spherical equivalent, and total operative time, were evaluated as potential confounders or effect modifiers. Results Mean pain-delta scores were significantly lower in the interventional group compared with controls (0.46 vs 2.22), representing a 1.76-point or 79% reduction in pain (p=0.003). On multiple linear regression, mid-procedure lidocaine remained independently associated with a 1.67-point reduction in pain-delta scores (95% CI: −2.83 to −0.50; p=0.006) after adjustment for demographic and perioperative factors. Conclusions A mid-procedure dose of lidocaine significantly reduces pain with intracameral moxifloxacin injection, independent of patient and perioperative variables. This simple, convenient, and low-cost intervention improves patient comfort and facilitates broader adoption of intracameral antibiotic prophylaxis during cataract surgery. Ophthalmology Cataract surgery Intracameral lidocaine Intracameral moxifloxacin Pain management Injection-related pain Patient comfort Figures Figure 1 Figure 2 Introduction Cataract extraction is one of the most common surgical procedures worldwide, with phacoemulsification and intraocular lens implantation in the capsular bag established as the standard of care [ 1 ]. Despite advancements in surgical techniques, postoperative endophthalmitis remains a rare but vision-threatening complication, affecting approximately 0.08% of cataract surgeries [ 2 ]. The use of periprocedural intracameral (IC) antibiotics has been shown to significantly reduce the risk of postoperative endophthalmitis, with or without the addition of topical antibiotics [ 3 ]. A meta-analysis of 14 studies found IC moxifloxacin use during cataract surgery to be associated with a 73% reduction in odds of endophthalmitis compared to standard care, i.e., povidone iodine with postoperative topical antibiotics and/or corticosteroids [ 4 ]. IC moxifloxacin is advantageous due to its safety profile, commercial availability, and ability to minimize patients' postoperative drop burden and as such, is now the primary choice of IC antibiotic among 83% of respondents to a survey conducted by the American Society of Cataract and Refractive Surgery [ 5 ]. It is usually administered at the end of cataract surgery, after intraocular lens insertion and removal of viscoelastic. However, one notable limitation is patient-reported discomfort immediately following injection, which has been observed to cause transient pain or burning sensations. While most studies on IC moxifloxacin have focused on its efficacy in reducing the risk of postoperative endophthalmitis, there are no published studies specifically evaluating patient discomfort associated with its administration. Because intraoperative pain is associated with decreased patient cooperation and satisfaction during and after cataract surgery [ 6 , 7 ], we aimed to investigate methods to prevent IC moxifloxacin pain intraoperatively. Current pain management during cataract surgery typically involves a combination of local and topical anesthetics, such as lidocaine, along with monitored anesthesia care [ 8 ]. IC lidocaine has been shown in prospective, controlled studies to be an effective adjunct to topical anesthesia to improve overall patient comfort and cooperation during cataract surgery [ 9 ]. It is usually administered intracamerally at the start of surgery following the first corneal incision. While effective initially, the lidocaine’s effects may diminish by the time of moxifloxacin injection at the end of surgery, as the anterior chamber is irrigated during phacoemulsification. During cataract surgery, there is a natural pause between nucleus extraction and cortex aspiration as the phacoemulsification instrument is exchanged for the irrigation-aspiration instrument, providing opportunity for the administration of additional anesthetic medication without extending operative time. This study evaluates whether an additional mid-procedure dose of IC lidocaine, administered at this timepoint, reduces pain associated with IC moxifloxacin injection, with the goal of improving patient comfort, cooperation, and satisfaction during cataract surgery while maintaining infection prophylaxis. Methods This prospective, single-center interventional study was conducted over six operating room days from August to September 2024. The study included 50 adult patients (aged ≥ 18 years), undergoing cataract surgery under monitored anesthesia care, all performed by a single surgeon at a high-volume academic center. Patients were excluded if they received intraoperative opioids (e.g., fentanyl), underwent general anesthesia, or had known allergies to lidocaine or moxifloxacin. Review of the charts was approved by the institutional review board of the University of California, Los Angeles under IRB-25-0214. All patients received an initial IC dose of 0.2 mL of 1% preservative-free lidocaine (2 mg) at the start of the procedure, administered immediately after the initial corneal incision. Patients were then assigned to one of two groups: the control group (n = 25), which received no additional lidocaine, or the interventional group (n = 25), which received a second 0.2 mL IC dose of 1% lidocaine (2 mg) administered during the instrument exchange between phacoemulsification and irrigation-aspiration phases of surgery. At the conclusion of the procedure, all patients received a 0.5 mL bolus of 0.1% IC moxifloxacin (0.5 mg) after the insertion of the intraocular lens and removal of viscoelastic. Pain scores were collected from patients at two time points: immediately before and after moxifloxacin injection. Pain was assessed using a verbal 0–10 numeric rating scale, where 0 represented no pain and 10 represented the most severe pain imaginable. The pain-delta was calculated as the difference between the post-injection and pre-injection pain scores. Pain-delta scores of > 2 and > 5 were designated as the threshold for moderate and severe pain, respectively, in response to moxifloxacin injection. Additional information was collected to analyze possible confounders and effect modifiers of the relationship between lidocaine and moxifloxacin-associated injection pain, including patient age, sex, midazolam dosage administered prior to surgery, pre-operative spherical equivalent, and total operative time. Statistical analysis Statistical analysis was performed using Microsoft Excel and R. Power analysis (assuming two independent groups with unequal variances, i.e., Welch planning formula) indicated a minimum of 19 patients per group (38 patients total) required to achieve sufficient statistical power. Descriptive analysis, including mean, median, and percentage calculations, were used to summarize patient demographic and surgical variables, and two-tailed t-tests assuming unequal variances (Welch’s t-test) were used to compare these variables across study groups. Within individual patient groups, paired two-tailed t-tests were used to compare mean pre- and post-injection pain scores to assess whether changes in pain scores in response to moxifloxacin injection were statistically significant. To evaluate differences in pain responses to moxifloxacin injection between the control and interventional groups, pain-delta scores, representing isolated pain responses to moxifloxacin, were calculated (post-injection minus pre-injection pain). A two-tailed t-test assuming unequal variances (Welch’s t-test) was then used to compare mean pain-delta scores between the control and interventional patient cohorts. A p-value less than 0.05 was considered statistically significant. A multiple linear regression analysis was performed to evaluate whether our primary intervention, additional intraoperative IC lidocaine, independently predicted our primary outcome, pain-delta, while adjusting for potential confounders selected based on clinical relevance: age, sex, midazolam dose, spherical equivalent, and surgery duration. All predictors were treated as continuous except sex (binary, with 0 = female and 1 = male) and the use of additional intra-operative lidocaine (0 = no additional lidocaine, 1 = additional lidocaine). During this analysis, one case with missing spherical equivalent data was excluded. To account for potential heteroscedasticity in patient-reported pain scores, we calculated robust standard errors. Regression correlation coefficients (β) are presented with robust 95% confidence intervals (CI). Statistical significance was defined as two-sided p < 0.05. Results 50 adult patients undergoing routine cataract surgery were included in the study, all operated by the same surgeon under consistent conditions. The control and interventional groups each comprised 25 patients. Mean age, midazolam dose, spherical equivalent, and surgical duration were comparable across groups (p-value = 0.91, 0.98, 0.61, and 0.14, respectively), and the interventional group comprised of a larger proportion of males (44%) than the control group (28%) (Table 1 ). Table 1 Patient and surgical characteristics of control and interventional groups. Age, midazolam dose, spherical equivalent, and surgical times are presented as mean (standard deviation), median, and range. For continuous variables, P-values for Welch’s t-test were performed, none of which show statistically significant differences across study groups. Sex distribution is reported as both absolute values and percentages. Patient and Surgical Variables by Study Group Control Group (n = 25) Interventional Group (n = 25) p-value Age (years) Mean (SD) 70.83 (7.25) 70.60 (7.83) 0.91 Median 71 69 Range 58–85 52–81 Sex , n (%) Males 7 (28%) 11 (44%) Females 18 (72%) 14 (56%) Midazolam Dose (milligrams) Mean (SD) 1.86 (0.78) 1.87 (0.71) 0.98 Median 2.00 2.00 Range 0.50-4.00 0.50–3.75 Spherical Equivalent (diopters) Mean (SD) 0.30 (3.37) -0.15 (2.66) 0.61 Median 1.19 0.25 Range -9.00 to 6.25 -8.13 to 5.00 Surgical Time (minutes) Mean (SD) 11 (4) 10 (3) 0.14 Median 10 9 Range 7–23 5–23 In the control group, the mean baseline pain score prior to moxifloxacin injection was 1.27. Following the injection, the mean pain score increased to 3.58, resulting in an average pain-delta of 2.22 on a 0–10 subjective pain scale. In the interventional group, the mean baseline pain score was 1.28, comparable to the control group. Post-injection, the mean pain score rose to 1.74, yielding an average pain-delta of 0.46. The reported increases in pain score after administration of moxifloxacin was found to be statistically significant in both the control (p = 0.00014) and the interventional (p = 0.037) groups. Pain-delta scores were significantly lower in the interventional group compared to the control group, with a mean difference of 1.76 (p = 0.003) (Table 2 ). Table 2 Mean pain scores and pain-delta values in control and interventional groups. Pain scores are provided by patients verbally on a scale of 0–10 before and after moxifloxacin injection, with the mean pain scores of each group presented below. Pain-delta was calculated as the difference between post- and pre-injection pain scores, with the mean pain-delta score of each group presented below. A paired two-tailed t-test was used to compare mean pre- and post-injection pain scores within individual groups, showing statistically significant increases in pain in both groups in response to moxifloxacin injection (p-values 0.00014 and 0.037). A two-tailed t-test assuming unequal variances (Welch’s t-test) demonstrates a statistically significant difference in mean pain-delta scores between the control and interventional groups (p = 0.003). Mean Pain Scores and Pain-Deltas by Study Group Control Group (n = 25) Interventional Group (n = 25) Between-group t-test P-value Mean pre-injection (baseline) pain score 1.27 1.28 — Mean post-injection pain score 3.58 1.74 — Mean pain-delta (post – pre-injection pain) 2.22 0.46 p = 0.003* Within-group t-test p-value p = 0.00014* p = 0.037* — *Indicates statistical significance, i.e., p < 0.05 Table 3 displays the individual pain scores and resulting pain-delta calculations of all 50 patients, exhibiting the variety in individual pain responses during cataract surgery. Patients were then classified depending on pain-delta severity (Table 4 ). Pain-deltas equal to 0 represent no pain response, pain-deltas above 0 up to 2 represent mild responses, pain-deltas above 2 up to 5 represent moderate responses, and pain responses above 5 represent severe responses. The interventional group demonstrated a substantially higher proportion of patients with no increase in pain (pain-delta = 0) compared to the control group (80% vs 28%, respectively), while the control group exhibited higher frequencies of mild, moderate, and severe pain responses. Notably, no patients in the interventional group experienced severe pain responses (pain-delta > 5), as compared to 4 patients (16%) in the control group. Figure 1 presents a visual representation of the distribution in pain-deltas between control and interventional groups. Table 3 Individual Patient Demographics and Pain Scores. Patients reported pain scores on a 0–10 verbal numeric rating scale immediately before and after intracameral (IC) moxifloxacin injection. Pain-delta was calculated as the difference between post- and pre-injection scores. Individual Patient Demographics and Pain Scores Control Group (n = 25) Interventional Group (n = 25) Patient No. (1) Pain before moxifloxacin (0–10) (2) Pain after moxifloxacin (0–10) Pain-Delta = (2)–(1) Patient No. (1) Pain before moxifloxacin (0–10) (2) Pain after moxifloxacin (0–10) Pain-Delta = (2)–(1) 1 1 1 0 26 3 4 1 2 2 2 0 27 3 5.5 2.5 3 1 1 0 28 0 0 0 4 0 0 0 29 3 5 2 5 2.5 3 0.5 30 0 0 0 6 5 5.5 0.5 31 0 0 0 7 0 0 0 32 1 1 0 8 0 6 6 33 0 0 0 9 1 1 0 34 2 2 0 10 1 6 5 35 0 0 0 11 5 7 2 36 0 0 0 12 1 1 0 37 7 7 0 13 3 4 1 38 0 0 0 14 0 4 4 39 0 0 0 15 0 5 5 40 1 3 2 16 0 8 8 41 6 6 0 17 0.5 3 2.5 42 5 5 0 18 0 2 2 43 1 1 0 19 0 6.5 6.5 44 0 0 0 20 1.5 4 2.5 45 0 0 0 21 1 2 1 46 0 0 0 22 1 2 1 47 0 0 0 23 3 4 1 48 0 0 0 24 1 2 1 49 0 0 0 25 0 6 6 50 0 4 4 Table 4 Distribution of pain-delta severities between groups. This table illustrates the distribution of pain-delta scores associated with moxifloxacin injection between the control and interventional group. The pain-delta scores, i.e., pain responses to moxifloxacin injection, are categorized as the following: none (0), mild (0 < x ≤ 2), moderate (2 5). The interventional group demonstrated a substantially higher proportion of patients with no increase in pain compared to the control group (80% vs 28%), while the control group exhibited higher frequencies of mild, moderate, and severe pain increases. Notably, no patients in the interventional group experienced severe pain increases. Control Group (n = 25) Interventional group (n = 25) Pain-Delta Category , n (%) Number of patients (%) Number of patients (%) None (= 0) 7 (28%) 20 (80%) Mild (0 < x ≤ 2) 9 (36%) 3 (12%) Moderate (2 5) 4 (16%) 0 (0%) Furthermore, given the disproportionate number of females to males in the overall study population (32 females [64%] vs. 18 males [36%]), and the unequal distribution of sexes across interventional and control groups (Table 1 ), we evaluated pain responses by sex to determine whether these differences influenced our results. Among the 50 total participants, 11 (22%) experienced moderate-to-severe pain (pain-delta > 2) following IC moxifloxacin injection. This proportion was consistent when stratified by sex, as 4 of 18 males (22%) and 7 of 32 females (22%) experienced moderate-to-severe pain. Additionally, sex distribution among patients experiencing moderate-to-severe pain responses (n = 11) mirrored that of the overall population (4 females [64%] vs. 7 males [34%]) (Table 5 ). This data suggests that sex does not affect pain responses. Table 5 Distribution of moderate and severe pain-delta scores by sex. This table summarizes the distribution of moderate-to-severe pain responses (defined as pain-delta > 2) across male and female participants. The number and proportion of participants with moderate-to-severe pain are also reported by sex. Moderate-to-Severe Pain Responses by Sex Males (n, %) Females (n, %) Total number across study (n = 50) 18 (36%) 32 (64%) Moderate and severe pain-delta (n = 11) 4 (36%) 7 (64%) Proportion of each sex experiencing moderate-to-severe pain (pain-delta > 2) 4/18 (22%) 7/32 (22%) In multiple linear regression analysis, IC lidocaine demonstrated a statistically significant association with decreased pain-delta (β = -1.67; 95% CI: -2.83 to -0.50, p = 0.006). This corresponds to an average reduction of approximately 1.7 points on the pain scale among patients receiving an additional dose of IC lidocaine compared with controls, after adjusting for all covariates. No other covariates, including age (β = 0.01; 95% CI: -0.07 to 0.09), sex (β = 0.40; 95% CI: -0.82 to 1.62), midazolam dose (β = 0.30; 95% CI: -0.52 to 1.11), spherical equivalent (β = 0.07; 95% CI: -0.13 to 0.26), or surgical duration (β = 0.13; 95% CI: -0.04 to 0.30), showed statistically significant association with pain-delta, suggesting no meaningful effect in this data set. Overall, these findings indicate that IC lidocaine was the only variable independently associated with reduced pain response to moxifloxacin injection, and no other measured patient or surgical factors appeared to confound or modify this relationship (Table 6 and Fig. 2 ). Table 6 Multiple Linear Regression Examining Predictors of Pain-Delta (post-injection minus pre-injection pain). Outcome: pain-delta (continuous). Negative beta correlation coefficients indicate lower pain responses to moxifloxacin (decreases in pain-delta). Only one variable, the use of additional intra-operative IC lidocaine, is with changes in pain-delta, resulting in a reduction of 1.67 pain points in response to moxifloxacin injection. Predictor Beta coefficient 95% CI p-value Intraoperative Lidocaine -1.67 -2.83 to -0.50 0.006* Age (years) 0.01 -0.07 to 0.09 0.78 Male sex 0.40 -0.82 to 1.62 0.52 Midazolam dose (milligrams) 0.30 -0.52 to 1.11 0.47 Spherical Equivalent (diopters) 0.07 -0.13 to 0.26 0.49 Surgical time (minutes) 0.13 -0.04 to 0.30 0.14 *Indicates statistical significance, i.e., p < 0.05 Discussion Interpretation of results. The demographic and surgical characteristics of the cohort were well balanced between the control and interventional groups, representative of a typical adult cataract surgery population. Despite unequal sex proportions within the entire cohort as well as between study groups, pain responses within sex groups closely mirrored that of the overall population, and sex distribution among patients experiencing moderate-to-severe pain reflected that of the overall population as well. As such, sex does not appear to influence pain responses. Additionally, sex was not statistically associated with pain-delta in multiple linear regression analysis. Baseline pain scores were nearly identical between the control and interventional groups (mean 1.27 vs. 1.28, respectively) prior to IC moxifloxacin injection. Following injection, both groups individually demonstrated statistically significant increases in reported pain. However, the interventional group reported mean post-injection pain scores approximately two points lower on a scale of 0–10 than the control group, demonstrating a blunted pain response to moxifloxacin injection. This demonstrates two points: 1. The IC injection of moxifloxacin at the end of cataract surgery does elicit a pain response, and 2. This pain response is reduced by 79% with the administration of additional lidocaine during cataract surgery (mean pain-delta 0.46 vs 2.22, p = 0.003). Additionally, the interventional group comprises nearly triple the number of patients who had no-pain responses to moxifloxacin (pain-delta = 0) than the control group (20 vs 7 patients, respectively), and importantly, did not have any patients that experienced severe pain in response to moxifloxacin (pain-delta > 5), compared to the 4 patients in the control group. Finally, in the multiple linear regression model, the administration of IC lidocaine was the only factor that independently predicted pain-delta. Patients receiving supplemental lidocaine were predicted to experience a 1.67-point reduction in pain in response to moxifloxacin, even after adjusting for demographic factors, baseline refractive status, sedation dose, and surgical duration. Compared to the pain-delta of the control group, 2.22, this means a predicted 75% reduction in moxifloxacin-associated pain. In summary, the use of additional IC lidocaine during cataract surgery is associated with a 1.67 to 1.76-point (75–79%) reduction in pain response to moxifloxacin injection. These findings support the conclusion that supplemental lidocaine provides a distinct and clinically significant analgesic effect during the administration of IC moxifloxacin during cataract surgery. Clinical relevance. Effective intraoperative pain management is essential for optimizing the patient experience, particularly for high-volume procedures such as cataract surgery. As surgical techniques, instrumentation, and technology continue to evolve, so too have perioperative pain control strategies. However, pain during elective procedures such as cataract surgery remains often under-recognized, underestimated, undertreated, and poorly understood [ 10 ]. While opioids are commonly used peri-procedurally for their sedative and analgesic effects, their use is associated with intraoperative hemodynamic changes and post-operative issues including prolonged anesthesia recovery times, respiratory depression, gastrointestinal side effects, and increased risk of chronic opioid use and opioid use disorder [ 8 , 10 – 11 ]. For example, one prospective cohort study finds that the use of sedatives and opioids reduced pain by 56%, but increased nausea and vomiting (odds ratio, 2.27) [ 12 ]. Given these risks, the investigation of safe, effective, non-opioid alternatives for intraoperative pain control is both timely and clinically relevant, particularly in settings where the judicious selection systemic medications is preferred or opioids are contraindicated. Other analgesic formulations, such as ketorolac 0.3% combined with phenylephrine and delivered continuously via irrigation during cataract surgery, offer promising pain control with additional anti-inflammatory and mydriatic benefits [ 13 , 14 ]. One randomized control trial found the use of phenylephrine-ketorolac to reduce pain by 48.9% (VAS score from 4.5 to 2.3) when compared to controls receiving IC epinephrine [ 14 ]. However, increased cost associated with this medication may limit its widespread use. In contrast, our study has demonstrated that additional IC lidocaine may reduce pain by 75–79%, offering comparable efficacy. Additionally, many surgeons already administer IC lidocaine at the start of routine cataract surgery, meaning that adding a supplemental dose incurs negligible additional cost. Therefore, our proposed intervention provides comparable analgesic effects with the added benefits of convenience, affordability, and avoidance of systemic side effects. Previous research has primarily focused on the efficacy of IC antibiotics such as moxifloxacin, cefuroxime, and vancomycin in reducing postoperative endophthalmitis [ 5 ]. To our knowledge, this study is the first to address patient-reported pain associated with IC moxifloxacin injection and evaluate the analgesic effect of an additional, mid-procedural dose of IC lidocaine for reducing this pain. Importantly, this additional dose can be administered by the cataract surgeon during the natural pause when the phacoemulsification handpiece is exchanged for the irrigation-aspiration instrument, without disrupting the procedure or extending operative time. Therefore, the use of IC lidocaine offers an efficacious and efficient means to reduce pain associated with moxifloxacin injection and serves as a promising alternative to other systemic or costly forms of anesthesia during routine cataract surgery. Study limitations and future directions. This study has several limitations, many of which highlight opportunities for future investigation. First, it was a single-center, single-surgeon study with a relatively small sample size. Power analysis determined that a minimum of 19 patients per group was required to detect a clinically meaningful difference. With 25 patients per group enrolled, this study exceeded this threshold and was sufficiently powered despite its modest size, supporting its validity as pilot data to guide future prospective, randomized, and multi-institutional studies. Additionally, other potential perioperative modifiers of pain, such as preoperative anxiety, previous surgical experiences (e.g., first vs second eye cataract surgery), degree of iris manipulation, or the use of IC mydriatics (e.g., phenylephrine), were not assessed. These variables have been shown in prior studies to influence intraoperative pain and call for further exploration [ 15 , 16 ]. Moreover, our assessment was limited to immediate pre- and post- injection pain. We selected our timepoints to address peri-injection pain, which we considered the most clinically relevant outcome based on our observation that moxifloxacin-related pain is brief and that immediate responses to moxifloxacin pain during injection poses significant safety concerns in the operative setting. This approach also minimized patient burden and improved reliability of reporting. However, we recognize that the inclusion of additional time points (e.g., delayed postoperative pain scores), may offer deeper insight into the utility of our intervention, and warrants future investigation as well. Comparative studies directly comparing the effectiveness of alternative anesthetic strategies, including agents such as bupivacaine, ketorolac, or opioids, as well as additional outcome measures such as visual function, complication rates, and safety profiles, can also help refine intraoperative pain management in cataract surgery. Given the connection between improved pain control and increased patient satisfaction and safety [ 17 ], future work may benefit from incorporating patient-reported outcomes to more comprehensively assess pain management effectiveness. In the United States, the use of IC antibiotics is not currently approved by the U.S. Food and Drug Administration (FDA) and is therefore considered off label [ 4 ]. As such, the precise mechanism by which IC moxifloxacin causes anterior chamber discomfort remains unclear. One potential explanation is that the discomfort arises from the drug’s intrinsic properties, such as its pH, which can range from 5.5 to 7.0. Other potential irritants include inactive ingredients and additives used for preservation and pH adjustment, including water, sodium chloride sodium acetate-trihydrate, disodium sulfate, sulfuric acid, edetate disodium dihydrate (also known as ethylenediaminetetraacetic acid, or EDTA), sodium hydroxide, hydrochloric acid, and so on. Notably, EDTA has been associated with injection-site pain as a common adverse drug reaction [ 18 ]. At present, there is limited literature examining the mechanism of pain associated with IC moxifloxacin, comparisons with other IC antibiotics, or strategies to optimize its administration for better patient comfort. Further investigation in these areas may enhance understanding of intraocular injection discomfort and inform alternative or adjunctive approaches to pain control. Although preservative-free 1% lidocaine is widely used in cataract surgery and is generally considered safe, our study focused on the effects of administering an additional intraoperative dose rather than increasing its concentration. Prior reviews, including the American Academy of Ophthalmology’s assessment of IC anesthesia, describe 1% preservative-free lidocaine as well-tolerated, with potential toxicity more strongly associated with higher concentrations rather than repeated standard-strength administration [ 19 ]. A separate evidence review similarly found moderate-quality evidence indicating that supplementing topical anesthesia with IC lidocaine does not appear to increase corneal endothelial toxicity or cell loss [ 20 ]. Conclusion Intracameral moxifloxacin is effective in reducing postoperative drop burden and infection risk in cataract surgery, yet its administration is associated with pain, compromising patient safety, comfort, and overall experience. Despite its widespread use, prior studies have not systematically characterized this pain or explored targeted preventative strategies. Our findings demonstrate that not only do patients experience a significant pain response to IC moxifloxacin at the end of surgery, but also that an additional, mid-procedure dose of IC lidocaine effectively and independently reduces this pain by 75–79%. The relationship between additional lidocaine and decreased pain levels was found to be independent of other patient and perioperative variables, including age, sex, pre-operative use of benzodiazepines, refractive status, or duration of surgery. This study, therefore, supports the additional dose of IC lidocaine as a simple, effective, convenient, and affordable means of enhancing patient comfort and safety during cataract surgery while supporting infection prophylaxis, without prolonging operative time. It also addresses a need to further advance and refine pain management strategies for cataract patients worldwide. Declarations Acknowledgements and Disclosures : The authors have no financial disclosures or conflicts of interest. 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Clin Ophthalmol 9:1249–1254. https://doi.org/10.2147/OPTH.S72321 Donnenfeld ED, Shojaei RD (2019) Effect of intracameral phenylephrine and ketorolac 1.0%/0.3% on intraoperative pain and opioid use during cataract surgery. Clin Ophthalmol 13:2143–2150. https://doi.org/10.2147/OPTH.S229515 Socea SD, Abualhasan H, Magen O, et al (2020) Preoperative anxiety levels and pain during cataract surgery. Curr Eye Res 45:471–476. https://doi.org/10.1080/02713683.2019.1666996 Shi C, Yuan J, Zee B (2019) Pain perception of the first eye versus the second eye during phacoemulsification under local anesthesia: a systematic review and meta-analysis. J Ophthalmol 2019:4106893. https://doi.org/10.1155/2019/4106893 Ahmad N, Zahoor A, Motowa SA, et al (2012) Satisfaction level with topical versus peribulbar anesthesia experienced by the same patient for phacoemulsification. Saudi J Anaesth 6:363–366. https://doi.org/10.4103/1658-354X.105866 Lanigan RS, Yamarik TA (2002) Final report on the safety assessment of EDTA and related compounds. Int J Toxicol 21(Suppl 2):95–142. https://doi.org/10.1080/10915810290096522 Karp CL, Cox TA, Wagoner MD, et al (2001) Intracameral anesthesia: a report by the American Academy of Ophthalmology. Ophthalmology 108:719–724. https://doi.org/10.1016/S0161-6420(00)00550-4 Minakaran N, Ezra DG, Allan BD (2020) Topical anaesthesia plus intracameral lidocaine versus topical anaesthesia alone for phacoemulsification cataract surgery in adults. Cochrane Database Syst Rev 7:CD005276. https://doi.org/10.1002/14651858.CD005276.pub4 Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8554780","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":571691639,"identity":"55ca709c-a3c1-425d-b309-d2e7fbc91d05","order_by":0,"name":"Mimi Giang, M.D.","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAs0lEQVRIiWNgGAWjYJCCAwwGNiCa8QADAzPRWtIYQKqJ1wIEh0nQIu/AnXjoRsH5xA3nzx84wFBhndhASIvhAd4Nh3MMbiduuJEMtOVMOhFaGiBacjfcADqMse0w0VrO5W44fxio5R8RWuQZwFoO5G44AHQYYwMRWgyYwVqS62feSDY4kHAs3ZiwLe29mz/n/LEz5jt/8OGDDzXWsoRtOYzMSyCkHGwLQUNHwSgYBaNgFAAAZDlG2Z61rI4AAAAASUVORK5CYII=","orcid":"https://orcid.org/0009-0009-2822-3592","institution":"Washington University in St. Louis School of Medicine, John F. Hardesty, MD, Department of Ophthalmology \u0026 Visual Sciences","correspondingAuthor":true,"prefix":"","firstName":"Mimi","middleName":"","lastName":"Giang","suffix":"M.D."},{"id":571691640,"identity":"9ddbe142-6805-4907-a439-ffe37b807327","order_by":1,"name":"Mitra Nejad, M.D.","email":"","orcid":"https://orcid.org/0000-0002-8554-946X","institution":"UCLA David Geffen School of Medicine, Jules Stein Eye Institute","correspondingAuthor":false,"prefix":"","firstName":"Mitra","middleName":"","lastName":"Nejad","suffix":"M.D."},{"id":571691641,"identity":"10c39cf8-550c-45fc-a6cf-f29abf3052a8","order_by":2,"name":"Tyler Kuk","email":"","orcid":"","institution":"UCLA David Geffen School of Medicine, Jules Stein Eye Institute","correspondingAuthor":false,"prefix":"","firstName":"Tyler","middleName":"","lastName":"Kuk","suffix":""},{"id":571691642,"identity":"93f4156e-40f6-4b81-8ae4-45557b74b2de","order_by":3,"name":"Shawn R. Lin, M.D., MBA","email":"","orcid":"https://orcid.org/0000-0001-8177-2624","institution":"UCLA David Geffen School of Medicine, Jules Stein Eye Institute","correspondingAuthor":false,"prefix":"","firstName":"M.D","middleName":"Shawn R.","lastName":"Lin","suffix":"M.D."}],"badges":[],"createdAt":"2026-01-08 19:54:14","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":true,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-8554780/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8554780/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":100023224,"identity":"d2579974-e836-4640-a7ba-80faf9e6fc18","added_by":"auto","created_at":"2026-01-12 08:11:29","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":94962,"visible":true,"origin":"","legend":"","description":"","filename":"GiangCombinedGraefeManuscript1726.docx","url":"https://assets-eu.researchsquare.com/files/rs-8554780/v1/679949e0ad064f78d7d396fb.docx"},{"id":100023187,"identity":"31f43ca9-ee6d-4f53-813b-58e2f07a60ae","added_by":"auto","created_at":"2026-01-12 08:11:25","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":342,"visible":true,"origin":"","legend":"","description":"","filename":"rs8554780.json","url":"https://assets-eu.researchsquare.com/files/rs-8554780/v1/c571888fdb3b0f662a59a6b4.json"},{"id":100362917,"identity":"1313ae91-ec7d-4608-9d43-1a0a54ca5b1a","added_by":"auto","created_at":"2026-01-16 07:48:16","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":100607,"visible":true,"origin":"","legend":"","description":"","filename":"rs85547800enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8554780/v1/67c4077d89da0978cf30cc35.xml"},{"id":100023186,"identity":"5675db2d-4375-4fb7-983f-58bb6e999bf4","added_by":"auto","created_at":"2026-01-12 08:11:25","extension":"jpeg","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":180131,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8554780/v1/a5b93521996994556959df51.jpeg"},{"id":100023293,"identity":"44b78855-63d0-43a1-9ce9-d54ff08e25ba","added_by":"auto","created_at":"2026-01-12 08:11:35","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":80224,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8554780/v1/f682871244403c179830a59d.png"},{"id":100023189,"identity":"125f9958-2ee1-49a7-881e-fb6d61f430a5","added_by":"auto","created_at":"2026-01-12 08:11:25","extension":"xml","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":99254,"visible":true,"origin":"","legend":"","description":"","filename":"rs85547800structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8554780/v1/3f4214cdc08d1bb3f5d049a1.xml"},{"id":100023191,"identity":"a0da3f62-efe3-42e2-9c7d-0e7750396c39","added_by":"auto","created_at":"2026-01-12 08:11:25","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":107235,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8554780/v1/b56a70b35a9b4fc7e7fb0129.html"},{"id":100023185,"identity":"fbf355bd-ff0c-401a-be86-993e470245e0","added_by":"auto","created_at":"2026-01-12 08:11:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":27257,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of pain-delta severities between control and interventional groups.\u003c/strong\u003e This bar graph provides a visual representation of Table 4, demonstrating the distribution of pain-delta scores associated with moxifloxacin injection between the control and interventional group.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8554780/v1/83b21675c455055ffb155094.png"},{"id":100362321,"identity":"99e8a6f6-a514-47dc-aaf1-ec4d156156c6","added_by":"auto","created_at":"2026-01-16 07:46:34","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":52855,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMultiple Linear Regression Examining Predictors of Pain-Delta.\u003c/strong\u003e Figure created by R software. Calculated with robust standard errors. X-axis represents estimated beta coefficients, representing predicted change in pain-delta with each predictor variable. Y-axis represents various predictor variables plotted. Error bars represent 95% confidence intervals. Blue color indicates statistically significant predictors (p \u0026lt; 0.05). The primary variable of interest, the use of additional intra-operative IC lidocaine, was significantly associated with a reduction in pain-delta. All other covariates (age, sex, midazolam dose, spherical equivalent, and surgical time), were not significant, with confidence intervals crossing the null value.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8554780/v1/3569278e46df7700e0099049.png"},{"id":100380957,"identity":"61c48096-4dda-4c2c-b5fe-86c2c91cbca3","added_by":"auto","created_at":"2026-01-16 10:36:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1334617,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8554780/v1/c334d384-b150-4dfc-b810-e570857c3243.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eEfficacy of Mid-Procedure Lidocaine in Reducing Pain from Intracameral Moxifloxacin Injection During Cataract Surgery\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCataract extraction is one of the most common surgical procedures worldwide, with phacoemulsification and intraocular lens implantation in the capsular bag established as the standard of care [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Despite advancements in surgical techniques, postoperative endophthalmitis remains a rare but vision-threatening complication, affecting approximately 0.08% of cataract surgeries [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The use of periprocedural intracameral (IC) antibiotics has been shown to significantly reduce the risk of postoperative endophthalmitis, with or without the addition of topical antibiotics [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A meta-analysis of 14 studies found IC moxifloxacin use during cataract surgery to be associated with a 73% reduction in odds of endophthalmitis compared to standard care, i.e., povidone iodine with postoperative topical antibiotics and/or corticosteroids [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIC moxifloxacin is advantageous due to its safety profile, commercial availability, and ability to minimize patients' postoperative drop burden and as such, is now the primary choice of IC antibiotic among 83% of respondents to a survey conducted by the American Society of Cataract and Refractive Surgery [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. It is usually administered at the end of cataract surgery, after intraocular lens insertion and removal of viscoelastic. However, one notable limitation is patient-reported discomfort immediately following injection, which has been observed to cause transient pain or burning sensations. While most studies on IC moxifloxacin have focused on its efficacy in reducing the risk of postoperative endophthalmitis, there are no published studies specifically evaluating patient discomfort associated with its administration. Because intraoperative pain is associated with decreased patient cooperation and satisfaction during and after cataract surgery [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], we aimed to investigate methods to prevent IC moxifloxacin pain intraoperatively.\u003c/p\u003e \u003cp\u003eCurrent pain management during cataract surgery typically involves a combination of local and topical anesthetics, such as lidocaine, along with monitored anesthesia care [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. IC lidocaine has been shown in prospective, controlled studies to be an effective adjunct to topical anesthesia to improve overall patient comfort and cooperation during cataract surgery [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. It is usually administered intracamerally at the start of surgery following the first corneal incision. While effective initially, the lidocaine\u0026rsquo;s effects may diminish by the time of moxifloxacin injection at the end of surgery, as the anterior chamber is irrigated during phacoemulsification. During cataract surgery, there is a natural pause between nucleus extraction and cortex aspiration as the phacoemulsification instrument is exchanged for the irrigation-aspiration instrument, providing opportunity for the administration of additional anesthetic medication without extending operative time. This study evaluates whether an additional mid-procedure dose of IC lidocaine, administered at this timepoint, reduces pain associated with IC moxifloxacin injection, with the goal of improving patient comfort, cooperation, and satisfaction during cataract surgery while maintaining infection prophylaxis.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis prospective, single-center interventional study was conducted over six operating room days from August to September 2024. The study included 50 adult patients (aged\u0026thinsp;\u003cb\u003e\u0026ge;\u003c/b\u003e\u0026thinsp;18 years), undergoing cataract surgery under monitored anesthesia care, all performed by a single surgeon at a high-volume academic center. Patients were excluded if they received intraoperative opioids (e.g., fentanyl), underwent general anesthesia, or had known allergies to lidocaine or moxifloxacin. Review of the charts was approved by the institutional review board of the University of California, Los Angeles under IRB-25-0214.\u003c/p\u003e \u003cp\u003eAll patients received an initial IC dose of 0.2 mL of 1% preservative-free lidocaine (2 mg) at the start of the procedure, administered immediately after the initial corneal incision. Patients were then assigned to one of two groups: the control group (n\u0026thinsp;=\u0026thinsp;25), which received no additional lidocaine, or the interventional group (n\u0026thinsp;=\u0026thinsp;25), which received a second 0.2 mL IC dose of 1% lidocaine (2 mg) administered during the instrument exchange between phacoemulsification and irrigation-aspiration phases of surgery.\u003c/p\u003e \u003cp\u003eAt the conclusion of the procedure, all patients received a 0.5 mL bolus of 0.1% IC moxifloxacin (0.5 mg) after the insertion of the intraocular lens and removal of viscoelastic. Pain scores were collected from patients at two time points: immediately before and after moxifloxacin injection. Pain was assessed using a verbal 0\u0026ndash;10 numeric rating scale, where 0 represented no pain and 10 represented the most severe pain imaginable. The pain-delta was calculated as the difference between the post-injection and pre-injection pain scores. Pain-delta scores of \u0026gt;\u0026thinsp;2 and \u0026gt;\u0026thinsp;5 were designated as the threshold for moderate and severe pain, respectively, in response to moxifloxacin injection.\u003c/p\u003e \u003cp\u003eAdditional information was collected to analyze possible confounders and effect modifiers of the relationship between lidocaine and moxifloxacin-associated injection pain, including patient age, sex, midazolam dosage administered prior to surgery, pre-operative spherical equivalent, and total operative time.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using Microsoft Excel and R. Power analysis (assuming two independent groups with unequal variances, i.e., Welch planning formula) indicated a minimum of 19 patients per group (38 patients total) required to achieve sufficient statistical power. Descriptive analysis, including mean, median, and percentage calculations, were used to summarize patient demographic and surgical variables, and two-tailed t-tests assuming unequal variances (Welch\u0026rsquo;s t-test) were used to compare these variables across study groups. Within individual patient groups, paired two-tailed t-tests were used to compare mean pre- and post-injection pain scores to assess whether changes in pain scores in response to moxifloxacin injection were statistically significant.\u003c/p\u003e \u003cp\u003eTo evaluate differences in pain responses to moxifloxacin injection between the control and interventional groups, pain-delta scores, representing isolated pain responses to moxifloxacin, were calculated (post-injection minus pre-injection pain). A two-tailed t-test assuming unequal variances (Welch\u0026rsquo;s t-test) was then used to compare mean pain-delta scores between the control and interventional patient cohorts. A p-value less than 0.05 was considered statistically significant.\u003c/p\u003e \u003cp\u003eA multiple linear regression analysis was performed to evaluate whether our primary intervention, additional intraoperative IC lidocaine, independently predicted our primary outcome, pain-delta, while adjusting for potential confounders selected based on clinical relevance: age, sex, midazolam dose, spherical equivalent, and surgery duration. All predictors were treated as continuous except sex (binary, with 0\u0026thinsp;=\u0026thinsp;female and 1\u0026thinsp;=\u0026thinsp;male) and the use of additional intra-operative lidocaine (0\u0026thinsp;=\u0026thinsp;no additional lidocaine, 1\u0026thinsp;=\u0026thinsp;additional lidocaine). During this analysis, one case with missing spherical equivalent data was excluded. To account for potential heteroscedasticity in patient-reported pain scores, we calculated robust standard errors. Regression correlation coefficients (β) are presented with robust 95% confidence intervals (CI). Statistical significance was defined as two-sided p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e50 adult patients undergoing routine cataract surgery were included in the study, all operated by the same surgeon under consistent conditions. The control and interventional groups each comprised 25 patients. Mean age, midazolam dose, spherical equivalent, and surgical duration were comparable across groups (p-value\u0026thinsp;=\u0026thinsp;0.91, 0.98, 0.61, and 0.14, respectively), and the interventional group comprised of a larger proportion of males (44%) than the control group (28%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003ePatient and surgical characteristics of control and interventional groups.\u003c/b\u003e Age, midazolam dose, spherical equivalent, and surgical times are presented as mean (standard deviation), median, and range. For continuous variables, P-values for Welch\u0026rsquo;s t-test were performed, none of which show statistically significant differences across study groups. Sex distribution is reported as both absolute values and percentages.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003ePatient and Surgical Variables by Study Group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInterventional Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.83 (7.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70.60 (7.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58\u0026ndash;85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52\u0026ndash;81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e, \u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFemales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMidazolam Dose (milligrams)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.86 (0.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.87 (0.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.50-4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.50\u0026ndash;3.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSpherical Equivalent (diopters)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.30 (3.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.15 (2.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-9.00 to 6.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-8.13 to 5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgical Time (minutes)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u0026ndash;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u0026ndash;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the control group, the mean baseline pain score prior to moxifloxacin injection was 1.27. Following the injection, the mean pain score increased to 3.58, resulting in an average pain-delta of 2.22 on a 0\u0026ndash;10 subjective pain scale. In the interventional group, the mean baseline pain score was 1.28, comparable to the control group. Post-injection, the mean pain score rose to 1.74, yielding an average pain-delta of 0.46. The reported increases in pain score after administration of moxifloxacin was found to be statistically significant in both the control (p\u0026thinsp;=\u0026thinsp;0.00014) and the interventional (p\u0026thinsp;=\u0026thinsp;0.037) groups. Pain-delta scores were significantly lower in the interventional group compared to the control group, with a mean difference of 1.76 (p\u0026thinsp;=\u0026thinsp;0.003) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eMean pain scores and pain-delta values in control and interventional groups.\u003c/b\u003e Pain scores are provided by patients verbally on a scale of 0\u0026ndash;10 before and after moxifloxacin injection, with the mean pain scores of each group presented below. Pain-delta was calculated as the difference between post- and pre-injection pain scores, with the mean pain-delta score of each group presented below. A paired two-tailed t-test was used to compare mean pre- and post-injection pain scores within individual groups, showing statistically significant increases in pain in both groups in response to moxifloxacin injection (p-values 0.00014 and 0.037). A two-tailed t-test assuming unequal variances (Welch\u0026rsquo;s t-test) demonstrates a statistically significant difference in mean pain-delta scores between the control and interventional groups (p\u0026thinsp;=\u0026thinsp;0.003).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eMean Pain Scores and Pain-Deltas by Study Group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInterventional Group (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBetween-group t-test\u003c/p\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean pre-injection (baseline) pain score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean post-injection pain score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean pain-delta (post \u0026ndash; pre-injection pain)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.003*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWithin-group t-test p-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.00014*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.037*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*Indicates statistical significance, i.e., p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e displays the individual pain scores and resulting pain-delta calculations of all 50 patients, exhibiting the variety in individual pain responses during cataract surgery. Patients were then classified depending on pain-delta severity (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Pain-deltas equal to 0 represent no pain response, pain-deltas above 0 up to 2 represent mild responses, pain-deltas above 2 up to 5 represent moderate responses, and pain responses above 5 represent severe responses. The interventional group demonstrated a substantially higher proportion of patients with no increase in pain (pain-delta\u0026thinsp;=\u0026thinsp;0) compared to the control group (80% vs 28%, respectively), while the control group exhibited higher frequencies of mild, moderate, and severe pain responses. Notably, no patients in the interventional group experienced severe pain responses (pain-delta\u0026thinsp;\u0026gt;\u0026thinsp;5), as compared to 4 patients (16%) in the control group. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents a visual representation of the distribution in pain-deltas between control and interventional groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eIndividual Patient Demographics and Pain Scores.\u003c/b\u003e Patients reported pain scores on a 0\u0026ndash;10 verbal numeric rating scale immediately before and after intracameral (IC) moxifloxacin injection. Pain-delta was calculated as the difference between post- and pre-injection scores.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eIndividual Patient Demographics and Pain Scores\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eInterventional Group (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient No.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(1) Pain before moxifloxacin (0\u0026ndash;10)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2) Pain after moxifloxacin (0\u0026ndash;10)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePain-Delta = (2)\u0026ndash;(1)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePatient No.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(1) Pain before moxifloxacin (0\u0026ndash;10)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(2) Pain after moxifloxacin (0\u0026ndash;10)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePain-Delta = (2)\u0026ndash;(1)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eDistribution of pain-delta severities between groups.\u003c/b\u003e This table illustrates the distribution of pain-delta scores associated with moxifloxacin injection between the control and interventional group. The pain-delta scores, i.e., pain responses to moxifloxacin injection, are categorized as the following: none (0), mild (0\u0026thinsp;\u0026lt;\u0026thinsp;x\u0026thinsp;\u0026le;\u0026thinsp;2), moderate (2\u0026thinsp;\u0026lt;\u0026thinsp;x\u0026thinsp;\u0026le;\u0026thinsp;5), and severe (\u0026gt;\u0026thinsp;5). The interventional group demonstrated a substantially higher proportion of patients with no increase in pain compared to the control group (80% vs 28%), while the control group exhibited higher frequencies of mild, moderate, and severe pain increases. Notably, no patients in the interventional group experienced severe pain increases.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInterventional group (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePain-Delta Category\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNumber of patients (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eNumber of patients (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone (=\u0026thinsp;0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (80%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild (0\u0026thinsp;\u0026lt;\u0026thinsp;x\u0026thinsp;\u0026le;\u0026thinsp;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (12%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate (2\u0026thinsp;\u0026lt;\u0026thinsp;x\u0026thinsp;\u0026le;\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere (\u0026gt;\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFurthermore, given the disproportionate number of females to males in the overall study population (32 females [64%] vs. 18 males [36%]), and the unequal distribution of sexes across interventional and control groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), we evaluated pain responses by sex to determine whether these differences influenced our results. Among the 50 total participants, 11 (22%) experienced moderate-to-severe pain (pain-delta\u0026thinsp;\u0026gt;\u0026thinsp;2) following IC moxifloxacin injection. This proportion was consistent when stratified by sex, as 4 of 18 males (22%) and 7 of 32 females (22%) experienced moderate-to-severe pain. Additionally, sex distribution among patients experiencing moderate-to-severe pain responses (n\u0026thinsp;=\u0026thinsp;11) mirrored that of the overall population (4 females [64%] vs. 7 males [34%]) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). This data suggests that sex does not affect pain responses.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eDistribution of moderate and severe pain-delta scores by sex.\u003c/b\u003e This table summarizes the distribution of moderate-to-severe pain responses (defined as pain-delta\u0026thinsp;\u0026gt;\u0026thinsp;2) across male and female participants. The number and proportion of participants with moderate-to-severe pain are also reported by sex.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eModerate-to-Severe Pain Responses by Sex\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMales (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemales (n, %)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal number across study (n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (64%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate and severe pain-delta (n\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (64%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of each sex experiencing moderate-to-severe pain (pain-delta\u0026thinsp;\u0026gt;\u0026thinsp;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4/18 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7/32 (22%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn multiple linear regression analysis, IC lidocaine demonstrated a statistically significant association with decreased pain-delta (β = -1.67; 95% CI: -2.83 to -0.50, p\u0026thinsp;=\u0026thinsp;0.006). This corresponds to an average reduction of approximately 1.7 points on the pain scale among patients receiving an additional dose of IC lidocaine compared with controls, after adjusting for all covariates. No other covariates, including age (β\u0026thinsp;=\u0026thinsp;0.01; 95% CI: -0.07 to 0.09), sex (β\u0026thinsp;=\u0026thinsp;0.40; 95% CI: -0.82 to 1.62), midazolam dose (β\u0026thinsp;=\u0026thinsp;0.30; 95% CI: -0.52 to 1.11), spherical equivalent (β\u0026thinsp;=\u0026thinsp;0.07; 95% CI: -0.13 to 0.26), or surgical duration (β\u0026thinsp;=\u0026thinsp;0.13; 95% CI: -0.04 to 0.30), showed statistically significant association with pain-delta, suggesting no meaningful effect in this data set. Overall, these findings indicate that IC lidocaine was the only variable independently associated with reduced pain response to moxifloxacin injection, and no other measured patient or surgical factors appeared to confound or modify this relationship (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eMultiple Linear Regression Examining Predictors of Pain-Delta (post-injection minus pre-injection pain).\u003c/b\u003e Outcome: pain-delta (continuous). Negative beta correlation coefficients indicate \u003cem\u003elower\u003c/em\u003e pain responses to moxifloxacin (decreases in pain-delta). Only one variable, the use of additional intra-operative IC lidocaine, is with changes in pain-delta, resulting in a reduction of 1.67 pain points in response to moxifloxacin injection.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePredictor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBeta coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative Lidocaine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2.83 to -0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.006*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.07 to 0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.82 to 1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMidazolam dose (milligrams)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.52 to 1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpherical Equivalent (diopters)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.13 to 0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical time (minutes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.04 to 0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*Indicates statistical significance, i.e., p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e \u003cem\u003eInterpretation of results.\u003c/em\u003e The demographic and surgical characteristics of the cohort were well balanced between the control and interventional groups, representative of a typical adult cataract surgery population. Despite unequal sex proportions within the entire cohort as well as between study groups, pain responses within sex groups closely mirrored that of the overall population, and sex distribution among patients experiencing moderate-to-severe pain reflected that of the overall population as well. As such, sex does not appear to influence pain responses. Additionally, sex was not statistically associated with pain-delta in multiple linear regression analysis.\u003c/p\u003e \u003cp\u003eBaseline pain scores were nearly identical between the control and interventional groups (mean 1.27 vs. 1.28, respectively) prior to IC moxifloxacin injection. Following injection, both groups individually demonstrated statistically significant increases in reported pain. However, the interventional group reported mean post-injection pain scores approximately two points lower on a scale of 0\u0026ndash;10 than the control group, demonstrating a blunted pain response to moxifloxacin injection. This demonstrates two points: 1. The IC injection of moxifloxacin at the end of cataract surgery does elicit a pain response, and 2. This pain response is reduced by 79% with the administration of additional lidocaine during cataract surgery (mean pain-delta 0.46 vs 2.22, p\u0026thinsp;=\u0026thinsp;0.003). Additionally, the interventional group comprises nearly triple the number of patients who had no-pain responses to moxifloxacin (pain-delta\u0026thinsp;=\u0026thinsp;0) than the control group (20 vs 7 patients, respectively), and importantly, did not have any patients that experienced severe pain in response to moxifloxacin (pain-delta\u0026thinsp;\u0026gt;\u0026thinsp;5), compared to the 4 patients in the control group.\u003c/p\u003e \u003cp\u003eFinally, in the multiple linear regression model, the administration of IC lidocaine was the only factor that independently predicted pain-delta. Patients receiving supplemental lidocaine were predicted to experience a 1.67-point reduction in pain in response to moxifloxacin, even after adjusting for demographic factors, baseline refractive status, sedation dose, and surgical duration. Compared to the pain-delta of the control group, 2.22, this means a predicted 75% reduction in moxifloxacin-associated pain.\u003c/p\u003e \u003cp\u003eIn summary, the use of additional IC lidocaine during cataract surgery is associated with a 1.67 to 1.76-point (75\u0026ndash;79%) reduction in pain response to moxifloxacin injection. These findings support the conclusion that supplemental lidocaine provides a distinct and clinically significant analgesic effect during the administration of IC moxifloxacin during cataract surgery.\u003c/p\u003e \u003cp\u003e \u003cem\u003eClinical relevance.\u003c/em\u003e Effective intraoperative pain management is essential for optimizing the patient experience, particularly for high-volume procedures such as cataract surgery. As surgical techniques, instrumentation, and technology continue to evolve, so too have perioperative pain control strategies. However, pain during elective procedures such as cataract surgery remains often under-recognized, underestimated, undertreated, and poorly understood [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile opioids are commonly used peri-procedurally for their sedative and analgesic effects, their use is associated with intraoperative hemodynamic changes and post-operative issues including prolonged anesthesia recovery times, respiratory depression, gastrointestinal side effects, and increased risk of chronic opioid use and opioid use disorder [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. For example, one prospective cohort study finds that the use of sedatives and opioids reduced pain by 56%, but increased nausea and vomiting (odds ratio, 2.27) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Given these risks, the investigation of safe, effective, non-opioid alternatives for intraoperative pain control is both timely and clinically relevant, particularly in settings where the judicious selection systemic medications is preferred or opioids are contraindicated. Other analgesic formulations, such as ketorolac 0.3% combined with phenylephrine and delivered continuously via irrigation during cataract surgery, offer promising pain control with additional anti-inflammatory and mydriatic benefits [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. One randomized control trial found the use of phenylephrine-ketorolac to reduce pain by 48.9% (VAS score from 4.5 to 2.3) when compared to controls receiving IC epinephrine [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, increased cost associated with this medication may limit its widespread use. In contrast, our study has demonstrated that additional IC lidocaine may reduce pain by 75\u0026ndash;79%, offering comparable efficacy. Additionally, many surgeons already administer IC lidocaine at the start of routine cataract surgery, meaning that adding a supplemental dose incurs negligible additional cost. Therefore, our proposed intervention provides comparable analgesic effects with the added benefits of convenience, affordability, and avoidance of systemic side effects.\u003c/p\u003e \u003cp\u003ePrevious research has primarily focused on the efficacy of IC antibiotics such as moxifloxacin, cefuroxime, and vancomycin in reducing postoperative endophthalmitis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. To our knowledge, this study is the first to address patient-reported pain associated with IC moxifloxacin injection and evaluate the analgesic effect of an additional, mid-procedural dose of IC lidocaine for reducing this pain. Importantly, this additional dose can be administered by the cataract surgeon during the natural pause when the phacoemulsification handpiece is exchanged for the irrigation-aspiration instrument, without disrupting the procedure or extending operative time.\u003c/p\u003e \u003cp\u003eTherefore, the use of IC lidocaine offers an efficacious and efficient means to reduce pain associated with moxifloxacin injection and serves as a promising alternative to other systemic or costly forms of anesthesia during routine cataract surgery.\u003c/p\u003e \u003cp\u003e \u003cem\u003eStudy limitations and future directions.\u003c/em\u003e This study has several limitations, many of which highlight opportunities for future investigation. First, it was a single-center, single-surgeon study with a relatively small sample size. Power analysis determined that a minimum of 19 patients per group was required to detect a clinically meaningful difference. With 25 patients per group enrolled, this study exceeded this threshold and was sufficiently powered despite its modest size, supporting its validity as pilot data to guide future prospective, randomized, and multi-institutional studies.\u003c/p\u003e \u003cp\u003eAdditionally, other potential perioperative modifiers of pain, such as preoperative anxiety, previous surgical experiences (e.g., first vs second eye cataract surgery), degree of iris manipulation, or the use of IC mydriatics (e.g., phenylephrine), were not assessed. These variables have been shown in prior studies to influence intraoperative pain and call for further exploration [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMoreover, our assessment was limited to immediate pre- and post- injection pain. We selected our timepoints to address peri-injection pain, which we considered the most clinically relevant outcome based on our observation that moxifloxacin-related pain is brief and that immediate responses to moxifloxacin pain during injection poses significant safety concerns in the operative setting. This approach also minimized patient burden and improved reliability of reporting. However, we recognize that the inclusion of additional time points (e.g., delayed postoperative pain scores), may offer deeper insight into the utility of our intervention, and warrants future investigation as well.\u003c/p\u003e \u003cp\u003eComparative studies directly comparing the effectiveness of alternative anesthetic strategies, including agents such as bupivacaine, ketorolac, or opioids, as well as additional outcome measures such as visual function, complication rates, and safety profiles, can also help refine intraoperative pain management in cataract surgery. Given the connection between improved pain control and increased patient satisfaction and safety [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], future work may benefit from incorporating patient-reported outcomes to more comprehensively assess pain management effectiveness.\u003c/p\u003e \u003cp\u003eIn the United States, the use of IC antibiotics is not currently approved by the U.S. Food and Drug Administration (FDA) and is therefore considered off label [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. As such, the precise mechanism by which IC moxifloxacin causes anterior chamber discomfort remains unclear. One potential explanation is that the discomfort arises from the drug\u0026rsquo;s intrinsic properties, such as its pH, which can range from 5.5 to 7.0. Other potential irritants include inactive ingredients and additives used for preservation and pH adjustment, including water, sodium chloride sodium acetate-trihydrate, disodium sulfate, sulfuric acid, edetate disodium dihydrate (also known as ethylenediaminetetraacetic acid, or EDTA), sodium hydroxide, hydrochloric acid, and so on. Notably, EDTA has been associated with injection-site pain as a common adverse drug reaction [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. At present, there is limited literature examining the mechanism of pain associated with IC moxifloxacin, comparisons with other IC antibiotics, or strategies to optimize its administration for better patient comfort. Further investigation in these areas may enhance understanding of intraocular injection discomfort and inform alternative or adjunctive approaches to pain control.\u003c/p\u003e \u003cp\u003eAlthough preservative-free 1% lidocaine is widely used in cataract surgery and is generally considered safe, our study focused on the effects of administering an additional intraoperative dose rather than increasing its concentration. Prior reviews, including the American Academy of Ophthalmology\u0026rsquo;s assessment of IC anesthesia, describe 1% preservative-free lidocaine as well-tolerated, with potential toxicity more strongly associated with higher concentrations rather than repeated standard-strength administration [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. A separate evidence review similarly found moderate-quality evidence indicating that supplementing topical anesthesia with IC lidocaine does not appear to increase corneal endothelial toxicity or cell loss [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIntracameral moxifloxacin is effective in reducing postoperative drop burden and infection risk in cataract surgery, yet its administration is associated with pain, compromising patient safety, comfort, and overall experience. Despite its widespread use, prior studies have not systematically characterized this pain or explored targeted preventative strategies.\u003c/p\u003e \u003cp\u003eOur findings demonstrate that not only do patients experience a significant pain response to IC moxifloxacin at the end of surgery, but also that an additional, mid-procedure dose of IC lidocaine effectively and independently reduces this pain by 75\u0026ndash;79%. The relationship between additional lidocaine and decreased pain levels was found to be independent of other patient and perioperative variables, including age, sex, pre-operative use of benzodiazepines, refractive status, or duration of surgery.\u003c/p\u003e \u003cp\u003eThis study, therefore, supports the additional dose of IC lidocaine as a simple, effective, convenient, and affordable means of enhancing patient comfort and safety during cataract surgery while supporting infection prophylaxis, without prolonging operative time. It also addresses a need to further advance and refine pain management strategies for cataract patients worldwide.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003eAcknowledgements and Disclosures\u003c/u\u003e: The authors have no financial disclosures or conflicts of interest. No external funding was received for this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eRossi T, Romano MR, Iannetta D, et al (2021) Cataract surgery practice patterns worldwide: a survey. \u003cem\u003eBMJ Open Ophthalmol\u003c/em\u003e 6:e000464. https://doi.org/10.1136/bmjophth-2020-000464\u003c/li\u003e\n \u003cli\u003eChen A, Dun C, Schein OD, et al (2024) Endophthalmitis rates and risk factors following intraocular surgeries in the Medicare population from 2016 to 2019. \u003cem\u003eBr J Ophthalmol\u003c/em\u003e 108:232\u0026ndash;237\u003c/li\u003e\n \u003cli\u003eGower EW, Lindsley K, Tulenko SE, et al (2017) Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery. \u003cem\u003eCochrane Database Syst Rev\u003c/em\u003e 2:CD006364. https://doi.org/10.1002/14651858.CD006364.pub3\u003c/li\u003e\n \u003cli\u003eAnderson J, Young S, Cockerham G, et al (2022) Evidence brief: intracameral moxifloxacin for prevention of endophthalmitis after cataract surgery. Department of Veterans Affairs, Washington, DC\u003c/li\u003e\n \u003cli\u003eLieu AC, Jun JH, Afshari NA (2024) Intracameral antibiotics during cataract surgery: efficacy, safety, and cost\u0026ndash;benefit considerations. \u003cem\u003eCurr Opin Ophthalmol\u003c/em\u003e 35:50\u0026ndash;56. https://doi.org/10.1097/ICU.0000000000001010\u003c/li\u003e\n \u003cli\u003eAkkaya S, \u0026Ouml;zkurt YB, Aksoy S, K\u0026ouml;k\u0026ccedil;en HK (2017) Differences in pain experience and cooperation between consecutive surgeries in patients undergoing phacoemulsification. \u003cem\u003eInt Ophthalmol\u003c/em\u003e 37:545\u0026ndash;552. https://doi.org/10.1007/s10792-016-0295-3\u003c/li\u003e\n \u003cli\u003eKinga K, Ursula HK (2022) Survey of patient satisfaction after bilateral cataract surgery. \u003cem\u003eRom J Ophthalmol\u003c/em\u003e 66:36\u0026ndash;40. https://doi.org/10.22336/rjo.2022.9\u003c/li\u003e\n \u003cli\u003eDavidson RS, Donaldson K, Jeffries M, et al (2022) Persistent opioid use in cataract surgery pain management and the role of nonopioid alternatives. \u003cem\u003eJ Cataract Refract Surg\u003c/em\u003e 48:730\u0026ndash;740. https://doi.org/10.1097/j.jcrs.0000000000000860\u003c/li\u003e\n \u003cli\u003eNebbioso M, Livani ML, Santamaria V, et al (2018) Intracameral lidocaine as supplement to classic topical anesthesia for relieving ocular pain in cataract surgery. \u003cem\u003eInt J Ophthalmol\u003c/em\u003e 11:1932\u0026ndash;1935. https://doi.org/10.18240/ijo.2018.12.09\u003c/li\u003e\n \u003cli\u003eAlam A, Gomes T, Zheng H, et al (2012) Long-term analgesic use after low-risk surgery: a retrospective cohort study. \u003cem\u003eArch Intern Med\u003c/em\u003e 172:425\u0026ndash;430. https://doi.org/10.1001/archinternmed.2011.1827\u003c/li\u003e\n \u003cli\u003eInan UU, Sivaci RG, Ermis SS, Ozt\u0026uuml;rk F (2003) Effects of fentanyl on pain and hemodynamic response after retrobulbar block in patients having phacoemulsification. \u003cem\u003eJ Cataract Refract Surg\u003c/em\u003e 29:1137\u0026ndash;1142. https://doi.org/10.1016/S0886-3350(02)02053-9\u003c/li\u003e\n \u003cli\u003eKatz J, Feldman MA, Bass EB, et al (2000) Injectable versus topical anesthesia for cataract surgery: patient perceptions of pain and side effects. \u003cem\u003eOphthalmology\u003c/em\u003e 107:2054\u0026ndash;2060. https://doi.org/10.1016/S0161-6420(00)00359-6\u003c/li\u003e\n \u003cli\u003eLawuyi LE, Gurbaxani A (2015) The clinical utility of new combination phenylephrine/ketorolac injection in cataract surgery. \u003cem\u003eClin Ophthalmol\u003c/em\u003e 9:1249\u0026ndash;1254. https://doi.org/10.2147/OPTH.S72321\u003c/li\u003e\n \u003cli\u003eDonnenfeld ED, Shojaei RD (2019) Effect of intracameral phenylephrine and ketorolac 1.0%/0.3% on intraoperative pain and opioid use during cataract surgery. \u003cem\u003eClin Ophthalmol\u003c/em\u003e 13:2143\u0026ndash;2150. https://doi.org/10.2147/OPTH.S229515\u003c/li\u003e\n \u003cli\u003eSocea SD, Abualhasan H, Magen O, et al (2020) Preoperative anxiety levels and pain during cataract surgery. \u003cem\u003eCurr Eye Res\u003c/em\u003e 45:471\u0026ndash;476. https://doi.org/10.1080/02713683.2019.1666996\u003c/li\u003e\n \u003cli\u003eShi C, Yuan J, Zee B (2019) Pain perception of the first eye versus the second eye during phacoemulsification under local anesthesia: a systematic review and meta-analysis. \u003cem\u003eJ Ophthalmol\u003c/em\u003e 2019:4106893. https://doi.org/10.1155/2019/4106893\u003c/li\u003e\n \u003cli\u003eAhmad N, Zahoor A, Motowa SA, et al (2012) Satisfaction level with topical versus peribulbar anesthesia experienced by the same patient for phacoemulsification. \u003cem\u003eSaudi J Anaesth\u003c/em\u003e 6:363\u0026ndash;366. https://doi.org/10.4103/1658-354X.105866\u003c/li\u003e\n \u003cli\u003eLanigan RS, Yamarik TA (2002) Final report on the safety assessment of EDTA and related compounds. \u003cem\u003eInt J Toxicol\u003c/em\u003e 21(Suppl 2):95\u0026ndash;142. https://doi.org/10.1080/10915810290096522\u003c/li\u003e\n \u003cli\u003eKarp CL, Cox TA, Wagoner MD, et al (2001) Intracameral anesthesia: a report by the American Academy of Ophthalmology. \u003cem\u003eOphthalmology\u003c/em\u003e 108:719\u0026ndash;724. https://doi.org/10.1016/S0161-6420(00)00550-4\u003c/li\u003e\n \u003cli\u003eMinakaran N, Ezra DG, Allan BD (2020) Topical anaesthesia plus intracameral lidocaine versus topical anaesthesia alone for phacoemulsification cataract surgery in adults. \u003cem\u003eCochrane Database Syst Rev\u003c/em\u003e 7:CD005276. https://doi.org/10.1002/14651858.CD005276.pub4\u003cstrong\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"David Geffen School of Medicine at UCLA","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cataract surgery, Intracameral lidocaine, Intracameral moxifloxacin, Pain management, Injection-related pain, Patient comfort","lastPublishedDoi":"10.21203/rs.3.rs-8554780/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8554780/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIntracameral moxifloxacin administered at the conclusion of cataract surgery reduces postoperative drop burden and infection risk but may cause injection-related discomfort, potentially affecting patient safety and satisfaction. This study evaluated whether an additional mid-procedure dose of intracameral lidocaine could reduce pain associated with moxifloxacin injection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis prospective interventional study included 50 cataract surgery patients under monitored anesthesia care. The interventional group (n=25) received an additional intracameral dose of 1% preservative-free lidocaine during instrument exchange, while the control group (n=25) did not. All patients then received intracameral moxifloxacin at the end of surgery, reporting verbal 0-10 pain scores before and after injection. Pain-delta scores, representing pain responses to moxifloxacin, were compared between the two groups. Patient age, sex, midazolam dosage administered prior to surgery, pre-operative spherical equivalent, and total operative time, were evaluated as potential confounders or effect modifiers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMean pain-delta scores were significantly lower in the interventional group compared with controls (0.46 vs 2.22), representing a 1.76-point or 79% reduction in pain (p=0.003). On multiple linear regression, mid-procedure lidocaine remained independently associated with a 1.67-point reduction in pain-delta scores (95% CI: −2.83 to −0.50; p=0.006) after adjustment for demographic and perioperative factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA mid-procedure dose of lidocaine significantly reduces pain with intracameral moxifloxacin injection, independent of patient and perioperative variables. This simple, convenient, and low-cost intervention improves patient comfort and facilitates broader adoption of intracameral antibiotic prophylaxis during cataract surgery.\u003c/p\u003e","manuscriptTitle":"Efficacy of Mid-Procedure Lidocaine in Reducing Pain from Intracameral Moxifloxacin Injection During Cataract Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 08:11:16","doi":"10.21203/rs.3.rs-8554780/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c3223b54-13eb-428c-ae36-95523f8c910d","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":60839207,"name":"Ophthalmology"}],"tags":[],"updatedAt":"2026-01-12T08:11:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 08:11:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8554780","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8554780","identity":"rs-8554780","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}