What it means for a patient
- Repeat upper eyelid surgery can hurt more under local anesthesia alone because of scar tissue.
- Adding intravenous pain medicine to local anesthesia made patients more comfortable, with less tearing and less movement during surgery.
- Swelling and bruising were lower at one week in the combined group.
- The comparison was with local anesthesia alone. The study did not compare this approach with standard sedation.
- The authors call for more studies to separate the effect of each drug.
- Limits: the two groups were of unequal size (72 and 60).
Why this paper matters
It tested an opioid-based conscious analgesia protocol with local anesthesia for revision blepharoplasty and reported lower pain, tearing and movement during surgery.
Overview
Repeat (revisional) upper eyelid surgery is often more painful, because scar tissue makes the area more sensitive and local anesthesia alone may be poorly tolerated. The authors compared local anesthesia alone with local anesthesia plus intravenous oliceridine and low-dose alfentanil, two opioid pain medicines given while the patient stays awake. The trial was randomized and run at more than one center.
Findings
- 132 patients, January 2023 to January 2025.
- Combined group (oliceridine plus low-dose alfentanil plus local anesthesia): 72 patients.
- Local anesthesia alone: 60 patients.
- Pain scores were significantly lower in the combined group at all time points around surgery (P < 0.05).
- Reflex tearing during surgery: 6.9% combined vs 75.0% local only (P < 0.001).
- Excessive body movement: 14.6% vs 80.0% (P < 0.001).
- Swelling and bruising around the eyes were significantly lower at day 7 in the combined group (P < 0.05).
- FACE-Q intraoperative comfort score at 3 months: 88.6 ± 6.2 vs 76.4 ± 9.7 (P < 0.001).
- No severe adverse events occurred in either group.
- The journal assigned Level of Evidence I.
Terms
- Revisional blepharoplasty: a second or later eyelid surgery to correct or improve an earlier one.
- Hyperalgesia: increased sensitivity to pain.
- Conscious analgesia: pain medicine given through a vein while the patient stays awake and able to respond.
- Oliceridine: an intravenous opioid pain medicine.
- Alfentanil: a short-acting intravenous opioid pain medicine.
- Local anesthesia: numbing medicine injected at the surgical site.
- Reflex tearing: tears produced in response to pain or irritation.
- FACE-Q: a set of patient questionnaires for facial procedures.
- Ecchymosis: bruising.