Uday Devgan, MD, focuses his blog on premium-channel IOLs, including accommodating, multifocal, toric, and other innovative designs. Current techniques, research, trials, issues, and case studies will be presented with an emphasis on surgical and clinical pearls for maximizing patient results.

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, MD, MSEE
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 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.