Is intracameral lidocaine really effective in cataract surgery?
OBJECTIVE
To evaluate the usefulness of intracameral lidocaine in cataract surgery under topical anesthesia and especially if the patient wanted intravenous sedation preoperatively.


METHODS
In this prospective study 96 patients were randomly assigned to receive 0.5 cc of balanced salt solution (Group 1) or 1% unpreserved lidocaine (Group 2). Patients who wanted sedation received intravenous midazolam hydrochloride. All surgery was done by one surgeon using a clear corneal technique.


RESULTS
Mean pain scores were 0.73 (of a maximum 3) in Group 1 and 0.54 in Group 2; the difference between groups was not statistically significant. Forty patients in Group 1 (83%) and 44 patients in Group 2 (92%) reported no discomfort or only mild discomfort. The two study groups were comparable in need for intravenous midazolam. Logistic regression analysis showed a significant relationship between pain scores and intravenous sedation (p=0.02) but not with intracameral lidocaine or other tested variables. However, odds ratio for pain increased to 5.1 (95% CI; 1.29-20.41) in participants without intravenous sedation compared to those with sedation.


CONCLUSIONS
The results of the present study suggest that intravenous sedation preoperatively seems to be an important determinant to relieve the sensation of discomfort/pain during small incision cataract surgery, but intracameral lidocaine was shown not to have a clinically useful role.
Välimäki
J O
JO
Department of Ophthalmology, Central Hospital of Lahti, Lahti, Finland and Department of Ophthalmology, University of Tampere, Tampere, Finland. juha.valimaki@phks.fi
D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000867:Anterior Chamber / Q000187:drug effects*; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis; D017060:Patient Satisfaction; D018918:Phacoemulsification; D011446:Prospective Studies; D016896:Treatment Outcome
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D008012:Lidocaine; D008874:Midazolam