| Objective: To investigate the effectiveness of topical application of compound lidocaine cream and tetracaine hydrochloride gel to the skin of the upper eyelid in reducing the pain of local anesthetic injection in patients undergoing upper blepharoplasty.To compare the anesthetic effects of the two topical anesthetics at the different durations of application.To assess the patient’s tolerance of the two topical anesthetics and their effect on short-term postoperative recovery.Methods: This study was a prospective,double-blind,randomized,controlled clinical trial.The study included 60 patients who underwent upper blepharoplasty at the department of ophthalmology in the second hospital of Dalian medical university from January 2021 to January 2023.Patients were randomized 1:1:1 into a 30-minute group(Group A),a 60-minute group(Group B),and a blank control group according to the duration of topical anesthetic application.Prior to surgery,compound lidocaine cream and tetracaine hydrochloride gel were randomly applied to the upper eyelids by the same trained physician for each patient in both intervention groups and both eyelids received one of the two drugs separately.After a certain period of application,the surface anesthetic was wiped off and the local skin reaction was assessed,followed by a local anesthetic injection.All patients were assessed for local anesthetic injection pain on both eyelids after completion of the local anesthetic injection.The degree of swelling of the eyelids bilaterally was assessed in all patients one day(24 h)after surgery.Results:1.Local anesthetic injection painIn the control group,after assessing the patients’ bilateral eyelid local anesthetic injection pain,the mean value was taken with a final value of 6.7 ± 1.59.In group A,the local anesthetic injection pain score was 5.75 ± 1.62 for the tetracaine hydrochloride gel side of eyelid and 6.25 ± 1.48 for the compounded lidocaine cream side.There was no statistical difference in local anesthetic injection pain in either side of eyelids compared to the control group(P > 0.05)or compared to each other(P > 0.05).In Group B,the local anesthetic injection pain score was 4.65 ± 1.66 for the tetracaine hydrochloride gel side of eyelid and 5.5 ± 1.73 for the compound lidocaine cream side.There was a statistically significant difference in local anesthetic injection pain on both sides of eyelids compared to the control group,respectively(P < 0.001,P < 0.05).Similarly,comparing the compound side with the tetracaine hydrochloride gel side of eyelids also showed a statistically significant difference on local anesthetic injection pain(P < 0.05).There was a statistically significant difference in the local anesthetic injection pain on the side of tetracaine hydrochloride gel in group A compared with that in group B(P <0.05),while the side of compounded lidocaine cream didn’t show a statistical difference between the two groups(P > 0.05).2.Effects of age and gender on local anesthetic injection painMultiple linear regression analysis suggested that age was significantly negatively associated with local anesthetic injection pain(regression coefficient =-0.022,P < 0.05),while gender differences did not significantly affect the patients’ local anesthetic injection pain(regression coefficient = 0.368,P > 0.05).On further analysis of the gender differences,there was a statistically significant difference in local anesthetic injection pain between males and females in the control group(P < 0.05),and no statistical difference between Group A and Group B(all P > 0.05).3.Local cutaneous reactionsSlight skin erythema was observed in 6 patients in Group A(30%)and in 8 patients in Group B(40%)after the application of compound lidocaine cream.The main cutaneous reaction to tetracaine hydrochloride gel on the eyelids is local edema.The incidence of skin edema on the eyelids with tetracaine hydrochloride gel was 75%(15patients)in group A and 70%(14 patients)in group B.There was no statistical difference between the two comparisons(p > 0.05).Comparing the incidence of cutaneous reactions on the eyelids corresponding to the two anesthetics in groups A and B respectively,the difference was only statistically significant in group A(p < 0.01),while in group B the comparison between the two was not statistically significant(p =0.056).Overall,the incidence of cutaneous reactions of the upper eyelids in groups A and B was 72.5%(29 patients)for tetracaine hydrochloride gel and 35%(14 patients)for the compounded lidocaine cream,with an extremely statistically significant difference between the two comparisons(p < 0.001).4.Comparison of postoperative eyelid edemaIn the control group,after assessing the degree of edema of patients’ bilateral eyelids,the mean value was taken with a final value of 1.54 ± 0.92.In group A,the postoperative edema score was 1.65 ± 0.67 for the eyelid of the tetracaine hydrochloride gel side and 1.75 ± 0.72 for the compound lidocaine cream side.In group B,the postoperative edema score was 1.7 ± 0.66 for the eyelid of the tetracaine hydrochloride gel side and 1.55 ± 0.69 for the compound lidocaine cream side.In both experiment groups(Group A and B),whether the tetracaine hydrochloride gel or the compound lidocaine cream side of the eyelid showed no statistically significant difference in postoperative edema compared with the control group and compared with the paired side in one group or the same side in the other group(all P > 0.05).Conclusion: Both compound lidocaine cream and tetracaine hydrochloride gel were effective in reducing local anesthetic injection pain after 60 minutes of topical application to the upper eyelid skin.Tetracaine hydrochloride gel showed a stronger anesthetic effect with a higher frequency of cutaneous reactions compared to the compound lidocaine cream.Both topical anesthetics did not affect the degree of eyelid oedema on the first postoperative day(24 hours)after 30 minutes and 60 minutes of application. |
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