Unpreserved lidocaine to control discomfort during cataract surgery using topical anesthesia. A comparison of cataract surgery under topical anaesthesia with and without intracameral lignocaine. A randomized clinical trial of combined topical-intracameral anesthesia in cataract surgery. Safety and efficacy of intracameral injections of unpreserved lidocaine to reduce intraocular sensation. A comparison of patient comfort during cataract surgery with topical anesthesia versus topical anesthesia and intracameral lidocaine. Topical tetracaine versus topical tetracaine plus intracameral lidocaine for cataract surgery. Efficacy of supplementary intracameral lidocaine in routine phacoemulsification under topical anesthesia. A randomized controlled trial of intracameral lidocaine during phacoemulsification under topical anesthesia.
To determine whether intraoperative unpreserved lidocaine further decrease discomfort or pain during sutureless small incision cataract surgery and intraocular lens (IOL) implantation under topical anesthesia.
                Outpatient ambulatory surgical center.
                In this prospective controlled study, comparable eligible patients were randomized to receive 0.1 cc unpreserved lidocaine 1% or 0.1 cc balanced salt solution (BSS) (control group) in double-masked fashion. Study drugs were injected intracamerally 1 minute before phacoemulsification. A predefined uniform pain/discomfort scale was used for assessment during phacoemulsification and IOL insertion. A secondary study using a 0.5 cc dose was also performed.
                Twenty-six percent in the control group and 9% in the lidocaine group had discomfort pain scores of 2 or more; 10% in the BSS group felt increased pressure or pain during phacoemulsification. In the lidocaine group, discomfort was felt mainly during IOL insertion, possibly as a result of wound manipulation. During phacoemulsification, no patient in the lidocaine group reported pain; 2% felt increased pressure during phacoemulsification. A dose increase to 0.5 cc reduced any intraocular sensation to 3% in the lidocaine group. No patient in either group had significant cell loss or adverse events.
                Intraoperative lidocaine is safe and effective in controlling intraoperative discomfort. To compare the efficacy of intracameral unpreserved lignocaine with placebo during cataract surgery under topical anaesthesia.
                One hundred and thirty-five consecutive cases undergoing clear corneal phacoemulsification were enrolled in this single surgeon, prospective, double-masked, controlled trial. Patients were randomized into two groups, receiving either intracameral unpreserved lignocaine 1% or placebo (balanced salt solution). Systolic and diastolic blood pressure, pulse rate and peripheral oxygen saturation were recorded preoperatively and during phacoemulsification. The level of intraoperative pain was assessed by a numerical analogue scale ranging between 0 (no pain) and 10 (unbearable pain). Data were compared by Student t-test.
                Sixty-seven cases received lignocaine (group 1) and 68 received placebo (group 2). Average age was 75 years and 74 years, respectively. Systolic blood pressure, pulse rate, oxygen saturation and pain score showed no statistical difference (P = 0.241, 0.542, 0.712, 0.237, respectively). Diastolic blood pressure showed a weakly significant change (P = 0.023). Patients reported minimal discomfort during surgery in both groups.
                This study found no additional benefit of intracameral unpreserved lignocaine when performing routine clear corneal phacoemulsification under topical anaesthesia. To evaluate the level of patient discomfort during phacoemulsification and implantation of a foldable intraocular lens (IOL) while under topical lidocaine, alone or in combination with intracameral lidocaine.
                A prospective, randomized, controlled trial.
                Between January and July 1997, a total of 162 patients (162 eyes) scheduled for cataract surgery were randomly assigned to either the placebo group (topical anesthesia with intracameral balanced salt solution [group 1, n = 81]) or the interventional group (combined topical-intracameral anesthesia [group 2, n = 81]).
                All patients underwent temporal clear corneal phacoemulsification and implantation of a foldable silicone IOL. All patients received a minimum total of five doses (two drops per dose) of 2% topical lidocaine hydrochloride. Three doses were administered before surgery into the superior and inferior cul-de-sac at 10 minutes, 5 minutes, and immediately before the initial corneal incision. One dose was administered before the commencement of phacoemulsification and another dose before implantation of the IOL. In addition, all patients received an intracameral injection immediately after entrance into the anterior chamber. Patients in group 1 received a 0.5-ml injection of balanced salt solution, and those in group 2 received a 0.5-ml injection of 1% lidocaine.
                A 10-point visual analogue scale was used immediately after the surgery to assess each patient's overall severity of pain intraoperatively.
                Ninety percent of patients in group 1 and 95% in group 2 assigned a score of 0 or 1 to the level of intraoperative discomfort. The mean pain score +/- 1 standard deviation for group 1 was 0.63 +/- 0.68 and for group 2 was 0.37 +/- 0.58. The difference between the pain scores for the two groups was statistically significant (P = 0.0053). A small but significant proportion (15%) of patients in group 1 expressed distress when the ciliary body was stretched or the iris was manipulated with instruments.
                Although topical lidocaine alone provides adequate anesthesia for phacoemulsification and implantation of a foldable IOL, combined topical and intracameral administration of lidocaine can further minimize intraoperative discomfort. To determine the safety and efficacy of intracameral injections of unpreserved lidocaine to reduce intraocular sensation.
                Carolina Eye Associates, Southern Pines, North Carolina, USA.
                In this prospective study, 100 patients having phacoemulsification under topical anesthesia were randomly assigned to receive an intracameral injection of unpreserved lidocaine (0.5 cc of a 1% unpreserved solution) or balanced salt solution.
                Ninety-three patients completed the study. There were no significant between-group differences in cell density parameters or Kowa laser flare-cell meter measurements. Seventy-eight percent of lidocaine patients and 56% of controls reported no sensation (P = .048, Fisher's exact test).
                Intracameral injections of unpreserved lidocaine safely and effectively reduced intraocular sensation during phacoemulsification. To determine whether intraocular lidocaine increases patient comfort during cataract surgery while under topical anesthesia.
                Prospective, randomized, double-masked, placebo-controlled clinical trial.
                Both men and women between 45 and 85 years of age who were scheduled for elective cataract surgery while under topical anesthesia participated. Sixty-eight patients were randomized to each group.
                Patients were randomized to receive either topical anesthesia plus intracameral 1% preservative-free lidocaine or intracameral balanced salt solution.
                Patient assessment of pain during delivery of the anesthesia, surgery, and after surgery using a visual analog pain scale was measured. Patients also recorded the degree to which they were bothered by tissue manipulation and the microscope light. Surgeon assessments of operative conditions, patient cooperation, and intraoperative complications were recorded. The attending anesthesiologist recorded any required supplemental intravenous sedation and any increase in pulse or increase in blood pressure.
                There was no significant difference in patient-reported pain scores for delivery of anesthesia (P = 0.902), surgery (P = 0.170), or after surgery (P = 0.680). Patients in the lidocaine group reported being less bothered by tissue manipulation (P = 0.021). The surgeon assessment showed more patient cooperation in the lidocaine group (P = 0.043).
                Both topical anesthesia alone and topical anesthesia plus intracameral lidocaine provide good operative conditions for the surgeon and comfortable surgical circumstances for the patient. Injection of intraocular lidocaine increases patient cooperation and decreases the degree to which patients are bothered by tissue manipulation, two outcomes that justify its use. To compare topical tetracaine 0.5% alone and with intracameral lidocaine 1% as a local anesthetic agent in phacoemulsification with intraocular lens (IOL) implantation.
                The Toronto Hospital-Western Division, Toronto, Canada.
                Fifty-nine consecutive patients (60 eyes) having phacoemulsification with implantation of a foldable acrylic IOL (AcrySof) were randomized into 1 of 2 groups: The intracameral balanced salt solution (BSS) group received topical tetracaine 0.5% plus intracameral BSS; the intracameral lidocaine group received topical tetracaine 0.5% with preservative-free intracameral lidocaine 1%. The patients' subjective experience of pain was measured at 4 points during surgery using a 4-point pain scale. Patient and surgeon satisfaction with the anesthesia used was measured using a 5-point satisfaction scale. Central endothelial cell counts were obtained preoperatively and 1 month postoperatively. Best corrected visual acuity (BCVA) was measured preoperatively and 1 hour, 1 day, 1 week, and 1 month postoperatively.
                The mean pain score after phacoemulsification was significantly higher in the intracameral BSS group than in the intracameral lidocaine group (0.63 +/- 0.7 [SD] and 0.23 +/- 0.4, respectively, P < .019). The mean pain score at the end of surgery was also significantly higher in the intracameral BSS group than in the intracameral lidocaine group (0.60 +/- 0.6 and 0.21 +/- 0.4, respectively; P < .014). The surgeon satisfaction score was significantly lower for the intracameral BSS group than for the intracameral lidocaine group (3.90 +/- 1.2 and 4.73 +/- 0.8, respectively; P < .0007). There was no difference in patient satisfaction between the intracameral BSS and intracameral lidocaine groups (4.60 +/- 0.6 and 4.70 +/- 0.8). Endothelial cell loss 1 month postoperatively was similar between the 2 groups (6.1% +/- 8% and 6.7% +/- 6%). Ninety-seven percent of patients (29/30) in each group noted BCVA improvement from preoperatively. The rate of potential visual acuity recovery was similar in both groups.
                Topical tetracaine 0.5% with intracameral lidocaine was safe and effective in patients having phacoemulsification with IOL implantation. The advantage of using intracameral lidocaine 1% over a placebo was a significant decrease in the patients' subjective experience of pain and in the surgeon's satisfaction with the anesthesia used. None of the other parameters measured in this study differed significantly between the 2 groups. To determine whether the routine use of supplementary intracameral lidocaine has any benefit over topical anesthesia alone when performing phacoemulsification surgery.
                A prospective single-center, randomized, double-masked, clinical trial.
                A total of 204 patients undergoing phacoemulsification surgery with lens implantation under planned topical anesthesia.
                Patients were randomly allocated to receive either topical anesthesia plus 0.5 ml intracameral balanced salt solution or topical anesthesia plus 0.5 ml preservative-free 1% intracameral lidocaine.
                On the day after surgery, patients were asked to document the discomfort they had experienced using a visual analog scale. Intraoperative discomfort, postoperative discomfort, and discomfort caused by the microscope light were assessed.
                Multiple linear regression analysis did not show any significant relationship between the use of intracameral lidocaine and either intraoperative (P = 0.34) or postoperative (P = 0.45) pain scores. There was a small reduction in the discomfort caused by the operating microscope when intracameral lidocaine was used (P = 0.04).
                In this study, the routine use of intracameral lidocaine as a supplement to topical anesthesia was shown not to have a clinically useful role. To test the hypothesis that adjunctive intracameral 1% lidocaine reduces intraoperative pain during phacoemulsification using topical anesthesia.
                Prospective, double-masked, randomized, controlled trial.
                A total of 200 patients undergoing routine phacoemulsification under topical 1% tetracaine were studied.
                Randomization to 0.5 ml intracameral, unpreserved, epinephrine-free 1% lidocaine or placebo was conducted.
                Intraoperative pain was quantified by the patients using a 0-10 visual analog pain scale.
                Intraoperative pain scores (+/- standard deviation) for the lidocaine and control groups were 1.29 +/-1.24 and 1.44 +/- 1.33, respectively (P > 0.35).
                In a rigorously double-masked, prospective, randomized, controlled trial there was no significant reduction in intraoperative pain when intracameral 1% lidocaine was used during phacoemulsification under topical anesthesia.