Efficacy of supplementary intracameral lidocaine in routine phacoemulsification under topical anesthesia

Objective: To determine whether the routine use of supplementary intracameral lidocaine has any benefit over topical anesthesia alone when performing phacoemulsification surgery. Design: A prospective single-center, randomized, double-masked, clinical trial. Participants: A total of 204 patients undergoing phacoemulsification surgery with lens implantation under planned topical anesthesia. Methods: Patients were randomly allocated to receive either topical anesthesia plus 0.5 mi intracameral balanced salt solution or topical anesthesia plus 0.5 mi preservative-free 1% intracameral lidocaine. Main Outcome Measures: On the day after surgery, patients were asked to document the discomfort they had experienced using a visual analog scale. Intraoperative discomfort, postoperative discomfort, and discomfort caused by the microscope light were assessed. Results: Multiple linear regression analysis did not show any significant relationship between the use of intracameral lidocaine and either intraoperative (P = 0.34) or postoperative (P = 0.45) pain scores. There was a small reduction in the discomfort caused by the operating microscope when intracameral lidocaine was used (P = 0.04). Conclusions In this study, the routine use of intracameral lidocaine as a supplement to topical anesthesia was shown not to have a clinically useful role.