Buffered Versus Nonbuffered Local Anesthetics and Local Pain Scores in Upper Eyelid Blepharoplasty: Randomized Controlled Trial

Purpose: This split-face study aimed to see whether different types of local anesthetics or their buffered/nonbuffered combinations produce lower pain scores in upper eyelid blepharoplasty. Methods: The study involved 288 patients, randomly divided into 9 groups: 1) 2% lidocaine with epinephrine—Lid + Epi; 2) 2% lidocaine with epinephrine and 0.5% bupivacaine (1:1)—Lid + Epi + Bupi; 3) 2% lidocaine with 0.5% bupivacaine (1:1)—Lid + Bupi; 4) 0.5% bupivacaine—Bupi; 5) 2% lidocaine—Lid; 6) 4% articaine hydrochloride with epinephrine—Art + Epi; 7) buffered 2% lidocaine/epinephrine with sodium bicarbonate (SB) in a 3:1 ratio—Lid + Epi + SB; 8) buffered 2% lidocaine with SB in a 3:1 ratio—Lid + SB; 9) buffered 4% articaine hydrochloride/epinephrine with SB in a 3:1 ratio—Art + Epi + SB. Following the injection of the first eyelid and a 5-minute period of soft pressure on the injection site, patients were asked to rate their pain level on the Wong-Baker Face Pain Rating Visual Analogue Scale. Rating of the pain level was repeated 15 and 30 minutes following anesthetic administration. Results: The lowest pain scores at the first time point were observed in Lid + SB when compared with all of the other groups ( p < 0.05). At the final time point, significantly lower scores were also observed in Lid + SB, Lid + Epi + SB, and Art + Epi + SB when compared with the Lid + Epi group ( p < 0.05). Conclusion: These findings could help surgeons select an appropriate combination of local anesthetics, particularly in patients with lower pain threshold and tolerance because buffered combinations of local anesthetics produce significantly lower pain scores compared with nonbuffered solutions.