title: Topical tetracaine versus topical tetracaine plus intracameral lidocaine for cataract surgery.
abstract: OBJECTIVE
  To compare topical tetracaine 0.5% alone and with intracameral lidocaine 1% as a local anesthetic agent in phacoemulsification with intraocular lens (IOL) implantation.
  
  
  METHODS
  The Toronto Hospital-Western Division, Toronto, Canada.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Ophthalmology, Toronto Hospital-Western Division, Canada.
authors.forename: N S
authors.initials: NS
authors.lastname: Carino
authors.forename: A R
authors.initials: AR
authors.lastname: Slomovic
authors.forename: F
authors.initials: F
authors.lastname: Chung
authors.forename: A L
authors.initials: AL
authors.lastname: Marcovich
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D019162:Anesthetics, Combined; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000867:Anterior Chamber / Q000187:drug effects*; D002452:Cell Count; D004311:Double-Blind Method; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D007267:Injections; D019654:Lens Implantation, Intraocular; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D017060:Patient Satisfaction; D018918:Phacoemulsification; D011446:Prospective Studies; D013748:Tetracaine / Q000008:administration & dosage*; D014792:Visual Acuity
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D013748:Tetracaine; D008012:Lidocaine