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Rishi R. Doshi, Theodore Leng, Anne E. Fung; Povidone-iodine Before Lidocaine Gel Anesthesia Achieves Surface Antisepsis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5826.
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Topical gel anesthesia is gaining popularity for intravitreal injections and cataract surgery, but a potential risk exists in the gel’s physical ability to shield bacteria from povidone-iodine’s antiseptic action. The purpose of this project is to determine if application of 5% povidone-iodine solution prior to 2% lidocaine gel reduces bacterial growth to a degree comparable to application of povidone-iodine alone, and to determine if application of povidone-iodine for 5 seconds prior to lidocaine gel reduces bacterial growth to a degree comparable to application for 30 seconds.
Blood agar plates inoculated with Staphylococcus epidermidis were prepared using 2% lidocaine gel and 5% povidone-iodine solution in 8 groups as follows: 1) no treatment; 2) application of lidocaine gel; 3) application of lidocaine gel, followed by povidone-iodine for 30 seconds; 4) application of lidocaine gel, followed by povidone-iodine for 5 seconds; 5) application of povidone-iodine for 30 seconds; 6) application of povidone-iodine for 5 seconds; 7) application of povidone-iodine for 30 seconds, followed by lidocaine gel; 8) application of povidone-iodine for 5 seconds, followed by lidocaine gel. The plates were then incubated at 37 degrees Celsius for 24 hours, and the bacterial growth was determined by two graders.
Plates on which lidocaine gel was applied alone or prior to povidone-iodine had no statistically significant difference in bacterial counts compared to plates without any treatment (p=0.553 and p=0.485, respectively). Plates on which povidone-iodine was applied alone or prior to lidocaine gel demonstrated no bacterial growth, regardless of whether the antiseptic was retained on the plate for 5 seconds or for 30 seconds.
Povidone-iodine is effective at reducing bacterial counts when applied prior to lidocaine gel, regardless of whether the antiseptic has been present for 30 seconds or for just 5 seconds prior to administration of the anesthetic. Lidocaine gel was confirmed to be a barrier to antisepsis when administered prior to povidone-iodine.
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