For lower lid blepharoplasty I first do a block of the infra-orbital nerve (this usually numbs most of the lower lid) using 0.5% bupivacaine (Marcaine) with epinephrine. This is followed by direct injection of 2% lidocaine (Xylocaine) with epinephrine into the lower eyelid area. The epinephrine constricts small blood vessels, which prolongs the effect of the local anesthetic and reduces intra-operative bleeding and bruising. Marcaine and Xylocaine are “trade names” for the listed generic drugs.
To provide sedation, I use intra-muscular midazolam (Versed) and hydroxyzine (Vistaril). It is safer to use IM rather than IV administration of midazolam because the drug will enter the bloodstream more slowly, thus avoiding the risk of respiratory arrest associated with the IV route.