Enhancing Patient Comfort and Anaesthetic Efficacy in Upper-Eyelid Blepharoplasty: A Randomised Controlled Trial of Sodium Bicarbonate-Buffered Lidocaine

Background: Pain during local anaesthetic injection is a major concern for patients undergoing upper-eyelid blepharoplasty. Buffered lidocaine, adjusted with sodium bicarbonate, has been proposed to reduce injection discomfort and improve anaesthetic efficacy. Aim: To evaluate the effects of sodium bicarbonate-buffered lidocaine on pain perception, anaesthetic onset, efficacy, and surgical outcomes in blepharoplasty. Methods: A double-blind, randomised controlled trial was conducted among 124 adult patients undergoing upper-eyelid blepharoplasty at Alhokail Eye Center, Dammam. Participants were randomly assigned to receive either 2% lidocaine with epinephrine or the same solution buffered with 8.4% sodium bicarbonate (1:5 ratio). Primary outcomes included pain during injection (measured using a 100-mm visual analogue scale) and anaesthesia onset time. Secondary outcomes comprised anaesthetic volume used, duration of analgesia, intraoperative bleeding, postoperative ecchymosis, oedema, and satisfaction ratings. Results: Buffered lidocaine significantly reduced injection pain (mean VAS: 21.7 vs. 38.4 mm, p<0.001) and accelerated anaesthetic onset (mean: 68.7 vs. 94.2 seconds, p<0.001). It also required less anaesthetic volume (3.8 vs. 4.4 mL, p<0.001) and yielded higher patient (9.1 vs. 8.2, p<0.001) and surgeon satisfaction (4.7 vs. 4.1, p<0.001). No significant differences were observed in intraoperative bleeding or postoperative complications. Conclusion: Buffering lidocaine with sodium bicarbonate significantly enhances anaesthetic performance and patient experience during blepharoplasty without compromising safety. This low-cost, simple intervention should be considered in clinical practice.