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Lidocaine gel applied before povidone-iodine thwarts ocular surface antisepsis
Ophthalmic Surg Lasers Imaging. 2011;42:346-349.
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Topical lidocaine gel administered before povidone-iodine proved deleterious to ocular surface antisepsis, a study found.
"Povidone-iodine effectively reduces bacterial counts when applied alone or prior to lidocaine gel," the study authors said. "Povidone-iodine requires surface contact with bacteria to achieve antisepsis. Anesthetic gels form a physical barrier that can block contact between povidone-iodine and the ocular surface, essentially shielding bacteria between the gel and conjunctiva. The injecting needle or incisional blade may then carry these bacteria into the eye."
The laboratory study involved 40 blood agar plates inoculated with Staphylococcus epidermidis and treated sequentially with NDC (lidocaine hydrochloride jelly 2%, Akorn) and Betadine (povidone-iodine 5% solution, Alcon). The plates were incubated at 37°C for 24 hours. The number of colony-forming units (CFUs) was determined for each plate.
Study results showed no bacterial growth on plates on which povidone-iodine was applied alone or previous to lidocaine gel, regardless of whether the antiseptic remained on a plate for 5 seconds or 30 seconds.
Plates that were not treated with povidone-iodine or lidocaine accumulated a mean of 126.4 CFUs. Plates treated with lidocaine gel alone grew 118.4 CFUs. Plates treated with lidocaine gel previous to povidone-iodine developed 139.6 CFUs to 157.2 CFUs.
The difference between bacterial growth on plates not treated with povidone-iodine and those treated with lidocaine gel alone or previous to povidone-iodine was statistically insignificant, the authors said.