Lidocaine Gel versus Combined Topical Anesthesia Using Bupivacaine, Oxybuprocaine and Diclofenac Eyedrops in Cataract Surgery

Abstract

Purpose: To assess the safety and efficacy of two topical anesthesia regimes for cataract surgery. Methods: 21 patients received a combination of 4 times bupivacaine 0.5, oxybuprocaine and diclofenac eyedrops, 18 patients were given a single topical application of lidocaine gel 2%. A single intracameral injection of lidocaine 1% was administered to all subjects. Results: The extent to which the surgeon was bothered by patient motility was graded as low in about two thirds of all procedures. Patients reported lower intraoperative pain levels with a single application of lidocaine gel supplemented with intracameral lidocaine than with a fourfold application of the combination topical anesthesia plus intracameral anesthesia. Conclusions: A single application of lidocaine gel 2% combined with intracameral anesthesia provides at least as good analgesia than multiple administration of combined topical anesthesia supplemented with intracameral anesthesia and is equally safe.

Corneal anesthetic effect and ocular tolerance of 3.5% lidocaine gel in comparison with 0.5% aqueous proparacaine and 0.5% viscous tetracaine in normal canines

“…Similar pain scores were found between groups, although a greater percentage of patients in the tetracaine group required supplemental drops during the procedure to maintain comfort . Several additional studies subjectively measuring patient comfort showed the 2% lidocaine gel was well tolerated and in some cases superior in anesthetic effect compared to other common topical anesthetics . Unfortunately, comparison of these studies to ours proves difficult due to their subjectivity and inability of our patients to communicate pain level accurately.…”

“…In human and veterinary patients, 2% lidocaine gel preparations are routinely used to provide local anesthesia in several surgical procedures, including those of the upper airway, dental, urogenital, and gastrointestinal tract. Several studies have also demonstrated its efficacy in providing anesthesia for ophthalmic procedures in nonsedated humans . However, these 2% lidocaine gel preparations are used off label as they are not intended for ophthalmic use.…”

Safety, efficacy, and patient acceptability of lidocaine hydrochloride ophthalmic gel as a topical ocular anesthetic for use in ophthalmic procedures

“…Eight studies addressed the use of lidocaine gel in cataract surgery, [6][7][8][9][10][11][12][13] 4 in pterygium surgery, [14][15][16][17] 2 in trabeculectomy/Ahmed valve implantation, 18,19 and 1 on phaco/trabeculectomy combination procedures. 20 There were 2 papers on lidocaine gel for intravitreal injection, 21,22 and 1 on vitrectomy.…”

A Substantive Narrative Review on the Usage of Lidocaine in Cataract Surgery

“…This most likely indicates that this concentration is the bare minimum that needs to be utilized in order to achieve an analgesic effect within the patients. Although the majority of the studies used a concentration of 2% when treating patients with lidocaine, there were a few studies within the review that utilized lidocaine at concentrations of 1% and 1.5% [ 5 , 8 , 14 - 15 , 24 - 25 , 29 - 30 , 33 ]. This could potentially indicate that different patients have different thresholds to achieve the analgesic effect or that different procedures with variable combination agents require a lower concentration of lidocaine to ensure the safety of the patient.…”