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  • Blunt- vs. Sharp-Needle Anesthetic Injection in Upper Blepharoplasty

    By Marianne Doran and selected by Deepak P. Edward, MD
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    Journal Highlights

    JAMA Facial Plastic Surgery
    Published online Nov. 23, 2016

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    Although sharp needles are commonly used to administer anesthesia in upper blepharoplasty, Yu et al. evaluated the potential benefits of using blunt-needle injection instead. They found that use of blunt needles to administer local anesthesia for this procedure was less likely to cause hemorrhage and to require interventional pain procedures than use of sharp needles.

    In a randomized clinical trial in an academic medical setting in China, 44 patients, aged 18-56 years, underwent bilateral upper blepharoplasty. Patients received local anesthesia injections (lidocaine 2%; 27-gauge needle) with a blunt needle in 1 eyelid and a sharp needle in the other eyelid (the specific injection technique for each was ran­domly assigned). Patients self-evaluated the pain for each injection on a visual analog scale (VAS) ranging from 0 to 10 (lower score indicating less pain). In addition, after injection and skin in­cision, the eyelids of each patient were photographed, and the images were evaluated for bruising and hematoma by plastic surgeons who were masked as to the type of injection.

    The patients’ mean (SD) VAS scores were 5.48 (1.59) and 4.64 (1.67) for sharp and blunt needles, respectively (p = .002). The evaluation of photographs revealed bruising and/or hematoma in 11 eye­lids (25%) treated with sharp needles compared with 0 eyelids treated with blunt needles.

    The researchers stated that blunt needles are easier to use and less likely than sharp ones to cause inadvertent penetration of arteries or adjacent vital structures. Thus, blunt needles can re­duce complications, including bleeding, bruising, blood vessel impalement, and subsequent intravascular injection and hemorrhage.

    The researchers noted that, to their knowledge, this is the first prospective side-by-side comparison study of the 2 types of needles in upper blepharo­plasty. They concluded that use of blunt needles presents fewer complications, allows for a more accurate surgical procedure, and enables faster patient recovery.

    The original article can be found here.