Purpose: To determine whether intraoperative unpreserved lidocaine further decreases discomfort or pain during sutureless small incision cataract surgery and intraocular lens (IOL) implantation under topical anesthesia. Setting: Outpatient ambulatory surgical center. Methods: In this prospective controlled study, comparable eligible patients were randomized to receive 0.1 cc unpreserved lidocaine 1% or 0.1 cc balanced salt solution (BSS(R)) (control group) in double-masked fashion. Study drugs were injected intracamerally 1 minute before phacoemulsification. A predefined uniform pain/discomfort scale was used for assessment-during phacoemulsification and IOL insertion. A secondary study using a 0.5 cc dose was also performed. Results: Twenty-six percent in the control group and 9% in the lidocaine group had discomfort pain scores of 2 or more; 10% in the BSS group felt increased pressure or pain during phacoemulsification. In the lidocaine group, discomfort was felt mainly during IOL insertion, possibly as a result of wound manipulation. During phacoemulsification, no patient in the lidocaine group reported pain; 2% felt increased pressure during phacoemulsification. A dose increase to 0.5 cc reduced any intraocular sensation to 3% in the lidocaine group. No patient in either group had significant cell loss or adverse events. Conclusion: Intraoperative lidocaine is safe and effective in controlling intraoperative discomfort.
