A comparison of patient comfort during cataract surgery with topical anesthesia versus topical anesthesia and intracameral lidocaine

Objective: To determine whether intraocular lidocaine increases patient com fort during cataract surgery while under topical anesthesia. Design: Prospective, randomized, double-masked, placebo-controlled clinical trial. Participants: Both men and women between 45 and 85 years of age who were sc heduled for elective cataract surgery while under topical anesthesia partic ipated. Sixty-eight patients were randomized to each group. Intervention: Patients were randomized to receive either topical anesthesia plus intracameral 1% preservative-free lidocaine or intracameral balanced salt solution. Main Outcome Measures: Patient assessment of pain during delivery of the an esthesia, surgery, and after surgery using a visual analog pain scale was m easured. Patients also recorded the degree to which they were bothered by t issue manipulation and the microscope light. Surgeon assessments of operati ve conditions, patient cooperation, and intraoperative complications were r ecorded, The attending anesthesiologist recorded any required supplemental intravenous sedation and any increase in pulse or increase in blood pressur e. Results: There was no significant difference in patient-reported pain score s for delivery of anesthesia (P = 0.902), surgery (P = 0.170), or after sur gery (P = 0.680). Patients in the lidocaine group reported being less bothe red by tissue manipulation (P = 0.021). The surgeon assessment showed more patient cooperation in the lidocaine group (P = 0.043). Conclusions: Both topical anesthesia alone and topical anesthesia plus intr acameral lidocaine provide good operative conditions for the surgeon and co mfortable surgical circumstances for the patient. Injection of intraocular lidocaine increases patient cooperation and decreases the degree to which p atients are bothered by tissue manipulation, two outcomes that justify its use.