Prospective evaluation of pain and follow-up results when pre-cooling skin versus buffering lidocaine for upper blepharoplasty

Abstract

Objectives: To find out whether there is a difference in the incidence of injection pain and other complications using pre-cooling versus the buffered equivalent in upper blepharoplasty. Methods: A prospective, randomized study in patients scheduled for primary upper blepharoplasty was performed. Each subject was his/her own control by performing pre-cooling for 2 min before plain lidocaine injection in one eyelid, while the buffered solution injection was used in the other eyelid. Data were collected regarding injection pain, postoperative pain, bleeding, bruising, swelling and scar appearance. Results: Sixty patients participated in this study. Injection pain, checked immediately, revealed a mean operative pain rating of 2.20 ± 0.32 in the eye with pre-cooling versus 2.30 ± 0.35 in the buffered lidocaine (p = 0.074). A statistical difference was observed in postoperative pain after 2–4 h, with the pre-cooling group having a score of 4.00 ± 0.14 versus 4.40 ± 0.30 in the buffered lidocaine group (p = 0.021). The postoperative pain after 24 h was 2.00 ± 0.56 in the pre-cooling group versus 2.30 ± 0.23 in the buffered lidocaine group (p = 0.006). There were no statistical differences between the buffered and unbuffered lidocaine eyes after 2 days or 1 week in regard to postoperative pain, bleeding, swelling, bruising and scar appearance. Conclusions: Pre-cooling could induce similar injection pain relief to that of buffered lidocaine while maintaining longer postoperative anesthetic results than buffered lidocaine.

Keywords:

• Buffered lidocaine
• blepharoplasty
• complication
• injection pain
• pre-cooling

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

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