Comparison of Lidocaine Gel-Assisted Transconjunctival and Transcutaneous Local Anesthesia for Outpatient Eyelid Surgery.

PURPOSE: Determine whether transconjunctival local anesthesia using 2% lidocaine gel decreases pain perception in comparison with transcutaneous anesthesia in patients undergoing outpatient eyelid surgery.

METHODS

This is a randomized controlled clinical trial. This study approved by an institutional review board and adhered to the Declaration of Helsinki and the Health Insurance Portability and Accountability Act. A total of 120 patients undergoing bilateral upper or lower eyelid surgery were enlisted. Topical 2% lidocaine gel was administered to the palpebral conjunctiva for 1 minute, followed by a local transconjunctival injection. Local anesthetic was administered to the contralateral eyelid by a transcutaneous approach without use of topical anesthetic. Both injections were 1 ml of 1% lidocaine with epinephrine 1:100,000 on a 30-gauge needle. After each injection, patients rated the pain on a 0-to-10 visual analog scale. Patients were also asked for preference between the 2 sides.

RESULTS

The mean pain scores were 2.33 (standard deviation 0.98) for the transconjunctival side and 3.42 (standard deviation 0.88) for the transcutaneous side. The reduction in pain scores for lidocaine gel-treated sides was statistically significant (p < 0.001) when controlling for side of intervention, upper versus lower eyelid procedures, sex of participants, and type of procedure. In addition, 85% of participants found the transconjunctival injection to be less painful than the transcutaneous (p < 0.001).

CONCLUSIONS

Transconjunctival local anesthesia in conjunction with topical anesthesia with 2% lidocaine gel provides a clinically and statistically significant decrease in perceived pain when compared with transcutaneous anesthesia in patients undergoing outpatient eyelid surgery.