Double-Blind, Bilateral Pain Comparison with Simultaneous Injection of 2% Lidocaine versus Buffered 2% Lidocaine for Periocular Anesthesia

• Published in: Ophthalmology (Rochester, Minn.) Vol. 119; no. 10; pp. 2048 - 2052
• Main Authors: Welch, Mark N., DO, Czyz, Craig N., DO, FACOS, Kalwerisky, Kevin, MD, Holck, David E.E., MD, FACS, Mihora, Lisa D., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2012; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia, Local - methods; Anesthetics, Local - administration & dosage; Biological and medical sciences; Blepharoplasty; Buffers; Double-Blind Method; Epinephrine - administration & dosage; Eye Pain - diagnosis; Female; Humans; Hydrogen-Ion Concentration; Injections, Intraocular; Lidocaine - administration & dosage; Male; Medical sciences; Middle Aged; Miscellaneous; Ophthalmology; Orbit - drug effects; Pain Measurement; Prospective Studies; Rhytidoplasty; Sodium Bicarbonate; Blind; Bilateral; Anticonvulsant; Injection; Antiarrhythmic agent; Periphery; Local anesthetic; Eye; Pain; Periocular; Anesthesia; Organic amide; Ophthalmology; Lidocaine; Comparative study
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/j.ophtha.2012.05.029

Purpose Determine if raising the pH of 2% lidocaine with epinephrine 1:100 000 to a physiologic level decreases pain perception during periocular, subcutaneous anesthesia. Design Double-blind, prospective, randomized study. Simultaneous unilateral injections of buffered and unbuffered lidocaine solutions were given before surgery to patients having bilateral, periocular surgery. Participants Fifty-four consecutive patients (27 male and 27 female; mean age, 68 years; standard deviation, 11 years). Intervention Patients were given simultaneous injections of buffered and unbuffered 2% lidocaine with epinephrine 1:100 000. The needles were inserted simultaneously and the anesthesia was injected for a 20-second count for a total volume of 1.0 ml per injected side. Main Outcome Measures After the simultaneous injections, the patients were asked to rate the pain on each side on a Likert-type visual analog scale of 0 to 10. Results Sixty-five percent of patients preferred the buffered lidocaine with a scaled pain reduction of 0.9 ( P = 0.0005). Additionally, for the patients who believed that the buffered solution was less painful, the mean decrease in scaled pain rating was 2, for a 51% reduction in pain level ( P = 0.001). No gender differences were noted. Conclusions Buffering 2% lidocaine with epinephrine 1:100 000 with sodium bicarbonate 8.4% offers a clinically and statistically significant reduction in pain experienced by two-thirds of patients receiving periocular subcutaneous anesthesia. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.