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Prospective Randomized Evaluation of Short-Term Complications When Using Buffered or Unbuffered Lidocaine 1% With Epinephrine for Blepharoplasty Surgery

Narváez, Julio M.D.*; Wessels, Izak M.D.; Bacon, Gregory B.S.; Chin, Vernon R. M.D.; Baqai, Waheed K. M.P.H.; Zimmerman, Grenith J. Ph.D.§

Ophthalmic Plastic & Reconstructive Surgery: January-February 2010 - Volume 26 - Issue 1 - p 33-35
doi: 10.1097/IOP.0b013e3181b80c13
Original Article

Purpose: To determine whether there is a difference in the incidence of short-term complications using plain lidocaine with epinephrine versus the buffered equivalent in eyelid surgery.

Methods: The authors performed a prospective, double-masked, randomized study in patients scheduled for combined upper eyelid blepharoplasty and levator advancement ptosis repair surgery with local anesthesia. Exclusion criteria included: documented allergies to lidocaine and/or epinephrine; known pregnancy; profound cognitive impairment; inability to understand the visual analog scale or the informed consent; and previous eyelid surgery. Each subject was his/her own control by using the unbuffered local anesthetic in one eye, while the buffered solution was used in the other eye. The surgeon completed a specific standardized data collection form for quantifying both intraoperative and postoperative complications, such as bleeding, bruising, and edema. Data regarding pain on injection and postoperative pain were collected from patients using a visual analog pain scale.

Results: Thirty-nine patients were included in this study, of which 18 experienced less pain during the injection on the side where buffered lidocaine was used, 11 reported no difference, and 10 reported less pain in the eye injected with unbuffered lidocaine. Injection pain revealed a mean operative pain rating of 4.01 ± 2.45 in the eye with buffered lidocaine versus 4.49 ± 2.58 in the control (p = 0.06). There were no significant differences between the buffered and unbuffered lidocaine eyes as regards postoperative bleeding, swelling, or pain, and there was a trend toward less pain on injection with the buffered solution.

Conclusions: There were no significant differences in postoperative pain, swelling, or bleeding with the use of plain versus buffered lidocaine in eyelid surgery. There was a trend for the buffered anesthetic to cause less pain on injection.

There is no increase in short-term complications for upper eyelid surgery when using buffered local anesthetic.

*Department of Ophthalmology, †Loma Linda University, ‡Loma Linda University School of Medicine, and §Loma Linda University School of Allied Health Professions, Loma Linda, California, U.S.A.

Accepted for publication March 18, 2009.

None of the authors had any financial or marketing interests related to this manuscript.

Address correspondence and reprint requests to Julio Narváez, M.D., 11370 Anderson Street, FMO Suite 1800, Department of Ophthalmology, Loma Linda University School of Medicine, Loma Linda, CA 92350, U.S.A. E-mail:

© 2010 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.