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For upper eyelid surgery, a 60-minute application of 4% tetracaine gel offers a better reduction in local anesthetic injection pain when compared to lidocaine-prilocaine cream.
For patients undergoing upper eyelid blepharoplasty, the pain of local anesthetic injections can be a major concern, potentially affecting their willingness to undergo the procedure. Hence, a new study explored whether topical anesthetics—4% tetracaine gel (TG) and lidocaine-prilocaine cream (LPC)—could help reduce this discomfort while assessing their potential side effects.
A total of 60 volunteers were randomly divided into three equal groups: a 30-minute application group (Group A), a 60-minute application group (Group B), and a control group that did not get any topical anesthetic (Group C). Groups A & B received both 4% TG and a eutectic mixture of local anesthetics (EMLA) on opposite eyelids, while Group C underwent anesthetic injection without any prior topical anesthetic. The study primarily investigated pain levels during anesthetic injection, with secondary assessments focusing on local skin reactions and eyelid swelling within 24 hours post-surgery.
Group C reported an average NRS pain score of 6.65 ± 1.60. In Group A, the scores for 4% TG and EMLA-treated sides were 5.75 ± 1.62 and 6.25 ± 1.48, respectively, with no statistically significant difference. However, in Group B, 4% TG demonstrated a greater reduction in injection pain (4.65 ± 1.66) compared to EMLA (5.5 ± 1.73), with both showing statistical significance. A negative correlation was witnessed between age and local anesthetic injection pain (regression coefficient = -0.022), while gender exhibited minimal influence (regression coefficient = 0.368).
The duration of 4% TG and EMLA application had no vital impact on the incidence of cutaneous reactions. However, EMLA exhibited a lower frequency of skin reactions (35%) compared to 4% TG (72.5%), with a significant difference. Postoperative eyelid edema scores were 1.5 (1.0,2.0) in the control group. In case of Group A, both 4% TG and EMLA sides had a median score of 2.0 (1.0,2.0), while in case of Group B, the scores were 2.0 (1.0,2.0) for 4% TG and 1.0 (1.0,2.0) for EMLA.
Regarding eyelid edema, no substantial differences were found between the treatment groups and the control group, or between the 4% TG and EMLA sides within each group. To sum up, while 4% TG could improve patient comfort during anesthetic injection, its higher rate of skin reactions should be considered. Surgeons may need to weigh the benefits of better pain relief against the risk of irritation, particularly for those with sensitive skin.
BMC Ophthalmology
Efficacy of 4% tetracaine gel and lidocaine-prilocaine cream in reducing local anesthetic injection pain in upper eyelid blepharoplasty: a randomized, single-blinded, controlled trial
Hetian Sun et al.
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