Anterior chamber irrigation with unpreserved lidocaine 1% for anesthesia during cataract surgery

Purpose: To assess the effectiveness of using anterior chamber irrigation of unpreserved lidocaine 1% as anesthesia during cataract surgery. Setting: Private group ophthalmology practice. Methods: This study prospectively evaluated 1000 of 1012 consecutive eyes having temporal corneal incision cataract surgery to determine whether anterior chamber lidocaine provides adequate anesthesia for cataract surgery. Twelve eyes were excluded because the patients had preoperative sedation. Surgery on the remaining 1000 eyes was performed by one surgeon without patients receiving preoperative or intraoperative sedation or other medications other than the local anesthetic and dilating agents. Each received one drop of topical proparacaine before entering the operating room. After an initial corneal stab incision was made, 0.25 to 0.50 cc of unpreserved lidocaine 1% was irrigated into the anterior chamber. Results: One patient was so uncomfortable from the microscope that he required supplemental retrobulbar anesthesia. A second patient was extremely uncomfortable during the case but did not require supplemental anesthesia. Two patients received additional dosages of anesthetic because of discomfort late in the operation. The remaining 996 patients were comfortable and pain-free during the operation with a single dose of the anesthetic. Conclusion: Anterior chamber irrigation with unpreserved lidocaine 1% was an effective method for anesthetizing an eye for temporal corneal incision cataract surgery.