title: A Prospective, Comparative Study of the Pain of Local Anesthesia Using 2% Lidocaine, 2% Lidocaine With Epinephrine, and 2% Lidocaine With Epinephrine-Bupivicaine Mixture for Eyelid Surgery.
abstract: OBJECTIVE
  A mixture of 2% lidocaine with epinephrine and bupivacaine was developed to achieve the fast-onset anesthetic effect of lidocaine and the long-lasting effect of bupivacaine. The authors compared pain scores between 2% lidocaine, 2% lidocaine with epinephrine, and 2% lidocaine with epinephrine-bupivicaine mixture during local anesthesia for eyelid surgeries.
  
  
  METHODS
  This was a double-blind, randomized, prospective, comparative study. In total, 120 consecutive patients (43 males, 77 females, mean age = 47.2 ± 21.2) who underwent bilateral eyelid surgery under subcutaneous anesthesia were asked to report pain scores for each eye during the first injection of anesthesia. Each patient was randomly assigned to receive 1 of the 3 anesthetic agents in 1 eyelid, and 1 of the remaining 2 agents in the other.
  
  
  RESULTS
  The pH values of the 2% lidocaine, 2% lidocaine with epinephrine, and 2% lidocaine with epinephrine-bupivicaine mixture were 6.23 ± 0.21, 4.21 ± 0.37, and 3.87 ± 0.19, respectively. The pain scores of each were 4.3 ± 1.8, 5.1 ± 1.8, and 5.7 ± 1.9, respectively. The 2% lidocaine with epinephrine produced a statistically significantly higher pain score than 2% lidocaine (p = 0.044, generalized estimating equation method). The mixture also showed a significantly higher pain score than 2% lidocaine (p = 0.003, generalized estimating equation method).
  
  
  CONCLUSIONS
  Epinephrine seemed to increase subjective pain scores. Compared with 2% lidocaine with epinephrine, 2% lidocaine with epinephrine-bupivicaine mixture was not significantly different in terms of subjective symptoms or pH.
authors.affiliation: *Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea; †Lee Sang Yeul Eye Clinic, Seoul, Korea; and ‡Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jung-Woo
authors.initials: JW
authors.lastname: Han
authors.forename: Seung Kwan
authors.initials: SK
authors.lastname: Nah
authors.forename: Sang Yeul
authors.initials: SY
authors.lastname: Lee
authors.forename: Chang Yeom
authors.initials: CY
authors.lastname: Kim
authors.forename: Jin Sook
authors.initials: JS
authors.lastname: Yoon
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Jang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000627:therapeutic use*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D010147:Pain Measurement; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine; D004837:Epinephrine