This article is more than 5 years old. Information may no longer be current.
Use of epi-Shugarcaine in cataract surgery
The late Joel Shugar, MD, was an innovative ophthalmologist, and in addition to the creation of the Sidewinder Phaco Needle, he created a solution of buffered lidocaine that he termed "Shugarcaine." This worked well because it resulted in a non-stinging physiologic solution that provided good intracameral anesthesia; it was also well-tolerated due to the neutral pH.
 Joel K. Shugar |
With the addition of epinephrine to the mix, the solution worked well for additional dilation and to increase iris tone in cases of floppy iris syndrome. This new solution, "epi-Shugarcaine," has been my go-to agent for small pupils and floppy iris cases, and earlier today while in the operating room, it came in handy - making difficult cases into more manageable ones.
If you would like to prepare epi-Shugarcaine for use in your cases, here's the recipe from an e-mail I received from Dr Shugar just prior to his untimely death last year in a tragic sky-diving accident:
The recipe in whole cc quantities is 9 cc BSS Plus (Alcon), 3 cc 4% preservative-free lidocaine (Hospira) and 4 cc 1:1000 preservative-free, bisulfite-free epinephrine (American Regent). Plain BSS may safely be substituted for Plus, but the pH will be lower and the patient will have more sensation for a second or two until the lidocaine kicks in. If wishing to make up a small quantity, the easiest way is to draw up 1 cc of non-preserved, 4% lidocaine into 3 cc of BSS Plus, which makes 4 cc of regular Shugarcaine. Then discard 1 cc of this mixture (or use it for a case just requiring intracameral anesthetic) and draw 1 cc of the above specified 1:1000 epinephrine, which yields 4 cc of epi-Shugarcaine, enough for at least two cases.
References:
- Shugar JK. Use of epinephrine for IFIS prophylaxis. J Cataract Refract Surg. 2006;32(7):1074-1075.
- Shugar JK. Intracameral epinephrine for IFIS prophylaxis. Cataract & Refractive Surgery Today. 2006;6(9):72-74.
- Shugar JK. Prophylaxis for IFIS. J Cataract Refract Surg. 2007;33(6):942-943.