• Mark N Welch, Craig N Czyz, Kevin Kalwerisky, David E E Holck, and Lisa D Mihora.
• Department of Ophthalmology, Dwight David Eisenhower Army Medical Center, Augusta, Georgia, USA. mark.n.welch@gmail.com
• Ophthalmology. 2012 Oct 1;119(10):2048-52.

PurposeDetermine if raising the pH of 2% lidocaine with epinephrine 1:100 000 to a physiologic level decreases pain perception during periocular, subcutaneous anesthesia.DesignDouble-blind, prospective, randomized study. Simultaneous unilateral injections of buffered and unbuffered lidocaine solutions were given before surgery to patients having bilateral, periocular surgery.ParticipantsFifty-four consecutive patients (27 male and 27 female; mean age, 68 years; standard deviation, 11 years).InterventionPatients were given simultaneous injections of buffered and unbuffered 2% lidocaine with epinephrine 1:100 000. The needles were inserted simultaneously and the anesthesia was injected for a 20-second count for a total volume of 1.0 ml per injected side.Main Outcome MeasuresAfter the simultaneous injections, the patients were asked to rate the pain on each side on a Likert-type visual analog scale of 0 to 10.ResultsSixty-five percent of patients preferred the buffered lidocaine with a scaled pain reduction of 0.9 (P = 0.0005). Additionally, for the patients who believed that the buffered solution was less painful, the mean decrease in scaled pain rating was 2, for a 51% reduction in pain level (P = 0.001). No gender differences were noted.ConclusionsBuffering 2% lidocaine with epinephrine 1:100 000 with sodium bicarbonate 8.4% offers a clinically and statistically significant reduction in pain experienced by two-thirds of patients receiving periocular subcutaneous anesthesia.Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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