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.
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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.
- Shugar JK. Use of epinephrine for IFIS prophylaxis. J Cataract Refract
- 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.
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