Sun Hetian, Mei Yingxue, Zhu Li, Sun Zijing, Yan Jiacheng, Kikkawa Don O, Lu Wei
Department of Ophthalmology, The Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China.
Shiley Eye Institute, San Diego, CA, US.
BMC Ophthalmol. 2024 Dec 20;24(1):530. doi: 10.1186/s12886-024-03799-7.
The injection of local anesthetics, an extremely painful procedure, leads to a reduction of patients' acceptance.
To investigate the efficacy and adverse reactions of 4% tetracaine gel (TG) and lidocaine-prilocaine cream (LPC) on reducing the local anesthetic injection pain for upper eyelid blepharoplasty.
Sixty participants were equally divided into three groups. Each patient in two treatment groups was assigned a pair of eutectic mixture of local anesthetics (EMLA) and 4% TG, and the blank control group did not receive any topical anesthetic. The primary outcome was the pain score associated with anesthetic injection. The secondary outcomes included the local cutaneous reactions and eyelid edema in 24 h postoperatively.
The NRS score in the control group was 6.65 ± 1.60, in the 4% TG and EMLA sides of 5.75 ± 1.62 and 6.25 ± 1.48 in group A, without statistically significant (p = 0.334, 0.067, respectively). While in group B, the injection pain scores in 4% TG and EMLA sides were 4.65 ± 1.66 and 5.5 ± 1.73 (p < 0.001 and p = 0.031, respectively). A negative correlation was observed between age and LAIP (regression coefficient = -0.022), whereas gender had almost no impact (regression coefficient = 0.368). The administration duration of 4%TG and EMLA had no statistically significant effect on the cutaneous reactions observed on the patients' eyelids (p = 0.723, p = 0.507, respectively). However, the incidence of cutaneous reactions was 35% for EMLA, significantly lower than 72.5% for 4% TG (p < 0.001). The postoperative edema score of the control group was 1.5 (1.0,2.0), while in group A both 4% TG and EMLA sides scored 2.0 (1.0,2.0) and in group B they scored 2.0 (1.0,2.0) and 1.0 (1.0,2.0), respectively. Neither group showed significant differences in postoperative edema score compared to the control group, and there's also no significant difference was revealed comparing the 4% TG or EMLA side with the paired side in one group or the same side in the other group.
In comparison to LPC, 4% TG showed a stronger anesthetic effect on reducing injection pain after 60-minute application. It also generally presented a higher frequency of cutaneous reactions but didn't affect the eyelid edema 24 h postoperatively.
This study was registered at chictr.org (the first registration date is 03/04/2023, and the registration number is ChiCTR2300070153).
局部麻醉药注射是一种极其疼痛的操作，会降低患者的接受度。
探讨4%丁卡因凝胶（TG）和利多卡因-丙胺卡因乳膏（LPC）在上睑成形术局部麻醉注射镇痛中的疗效及不良反应。
60例受试者平均分为三组。两个治疗组的每位患者分别使用复方利多卡因乳膏（EMLA）和4%TG，空白对照组不使用任何局部麻醉药。主要观察指标为麻醉注射相关的疼痛评分。次要观察指标包括术后24小时的局部皮肤反应和眼睑水肿。
对照组的数字评分法（NRS）评分为6.65±1.60，A组4%TG侧和EMLA侧分别为5.75±1.62和6.25±1.48，差异无统计学意义（p分别为0.334、0.067）。而B组4%TG侧和EMLA侧的注射疼痛评分分别为4.65±1.66和5.5±1.73（p分别<0.001和p = 0.031）。年龄与局部麻醉注射疼痛呈负相关（回归系数=-0.022），而性别几乎无影响（回归系数=0.368）。4%TG和EMLA的用药时间对患者眼睑观察到的皮肤反应无统计学显著影响（p分别为0.723、0.507）。然而，EMLA的皮肤反应发生率为35%，显著低于4%TG的72.5%（p<0.001）。对照组术后水肿评分为1.5（1.0,2.0），A组4%TG侧和EMLA侧均为2.0（1.0,2.0），B组分别为2.0（1.0,2.0）和1.0（1.0,2.0）。与对照组相比，两组术后水肿评分均无显著差异，且比较4%TG或EMLA侧与同一组内配对侧或另一组内同侧也未发现显著差异。
与LPC相比，4%TG在应用60分钟后对减轻注射疼痛有更强的麻醉效果。它通常也表现出更高频率的皮肤反应，但不影响术后24小时的眼睑水肿。
本研究在chictr.org注册（首次注册日期为2023年4月3日，注册号为ChiCTR2300070153）。
