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Amy R. Kulak, Tanuj Nakra, Roman Shinder; Transconjunctival Local Anesthesia for Outpatient Eyelid Surgery. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1457.
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Eyelid surgery is often performed under local anesthesia in the office setting. Patients often have a fear of the pain involved during administration of local anesthesia, and this likely represents the period of maximum intraoperative discomfort. Multiple techniques have been advocated to address this concern including warming and buffering the local anesthetic, slow infiltration, using small caliber needle, vibration on the sensory nerves processing pain for the anatomic site, and topical skin anesthetic agents applied prior to injection. The most common current practice of local anesthesia is subcutaneous injection of lidocaine with epinephrine. This study describes our preferred method of local lid anesthesia, and documents patient satisfaction with this technique.
Patients first received topical 2% lidocaine jelly to the palpebral conjunctiva for 1 minute, followed by local anesthetic (1% lidocaine with epinephrine 1:100,000 on a 30 gauge needle) given transconjunctivally through the palpebral conjunctiva (fig 1,2). After injection patients were asked if the pain felt was mild, moderate or severe. The charts of 84 patients who underwent eyelid surgery with this technique were reviewed.
40 male and 44 female patients had a median age of 46 years (range 7-85). 47 cases involved the lower lid, while 37 involved the upper lid. Procedures included chalazion drainage (39), lesion excision (32), incisional biopsy (8), laceration repair (4), and cilia electrolysis (1). 76 patients (90%) reported mild pain, 8 (10%) reported moderate pain, and no patients reported severe pain. All procedures were completed without complications.
Transconjunctival local anesthesia in combination with topical 2% lidocaine jelly may be beneficial in alleviating injection pain in patients undergoing eyelid surgery in the office setting. We observed that patients do not feel the transconjunctival needle puncture, and only perceive pain during anesthetic infiltration. The majority of patients admitting to moderate pain during anesthesia had injection into the upper lid. This is likely attributed to the upper lid having a larger tarsal plate to be avoided by the needle tip, making transconjunctival infiltration more challenging.
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