ABSTRACT
Characteristics of alkalinized local anesthetics are poorly described with regard to stability and precipitation. Current fixed-volume methods of alkalinization often result in unstable, precipitated solutions of unpredictable pH. We determined a stable, nonprecipitating, anesthetic mixture and used it in a randomized double-blind crossover study of 21 patients to evaluate alkalinized anesthetic solutions in reducing pain on injection. Our solution significantly reduced pain associated with retrobulbar injection (analysis of variance, P = .0362) but not that associated with Nadbath injection. Fixed-volume alkalinization is not recommended because complications can result with the use of precipitated anesthetics.
Subject(s)
Anesthesia, Local/methods , Anesthetics, Local/chemistry , Anesthetics, Local/therapeutic use , Bupivacaine/chemistry , Bupivacaine/therapeutic use , Cataract Extraction , Chemical Precipitation , Cross-Over Studies , Double-Blind Method , Drug Stability , Drug Therapy, Combination , Epinephrine/chemistry , Epinephrine/therapeutic use , Humans , Hyaluronoglucosaminidase/chemistry , Hyaluronoglucosaminidase/therapeutic use , Hydrogen-Ion Concentration , Lidocaine/chemistry , Lidocaine/therapeutic use , Pain, Postoperative/prevention & control , Pilot Projects , Sodium BicarbonateABSTRACT
A 61-year-old woman developed acute bilateral dacryocystitis secondary to Staphylococcus aureus 3 weeks after undergoing punctal occlusion with thermal cautery for keratoconjunctivitis sicca. The dacryocystitis resolved with intravenous antibiotics, aspiration of the lacrimal sacs, injection of sulfacetamide into the lacrimal sacs, and bilateral dacryocystorhinostomy. Preexisting bilateral nasolacrimal duct obstruction was postulated as the underlying cause. In these cases, irrigation of the lacrimal system is recommended before proceeding with punctal occlusion.