Comparison of Lidocaine Gel-Assisted Transconjunctival and Transcutaneous Local Anesthesia for Outpatient Eyelid Surgery.

Purpose: Determine whether transconjunctival local anesthesia using 2% lidocaine gel decreases pain perception in comparison with transcutaneous anesthesia in patients undergoing outpatient eyelid surgery.
Methods: This is a randomized controlled clinical trial. This study approved by an institutional review board and adhered to the Declaration of Helsinki and the Health Insurance Portability and Accountability Act. A total of 120 patients undergoing bilateral upper or lower eyelid surgery were enlisted. Topical 2% lidocaine gel was administered to the palpebral conjunctiva for 1 minute, followed by a local transconjunctival injection. Local anesthetic was administered to the contralateral eyelid by a transcutaneous approach without use of topical anesthetic. Both injections were 1 ml of 1% lidocaine with epinephrine 1:100,000 on a 30-gauge needle. After each injection, patients rated the pain on a 0-to-10 visual analog scale. Patients were also asked for preference between the 2 sides.
Results: The mean pain scores were 2.33 (standard deviation 0.98) for the transconjunctival side and 3.42 (standard deviation 0.88) for the transcutaneous side. The reduction in pain scores for lidocaine gel-treated sides was statistically significant (p < 0.001) when controlling for side of intervention, upper versus lower eyelid procedures, sex of participants, and type of procedure. In addition, 85% of participants found the transconjunctival injection to be less painful than the transcutaneous (p < 0.001).
Conclusions: Transconjunctival local anesthesia in conjunction with topical anesthesia with 2% lidocaine gel provides a clinically and statistically significant decrease in perceived pain when compared with transcutaneous anesthesia in patients undergoing outpatient eyelid surgery.