Buffering the pain of local anaesthetics: A systematic review

Davies, Robert John

doi:10.1046/j.1442-2026.2003.00413.x

Cited by 73 publications

(68 citation statements)

References 55 publications

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“…Buffering of local anesthetics is a recommended way of reducing pain for intradermal injections [9,10,15,24], although one study evaluating buffering of intraarticular prilocaine for pain control was inconclusive regarding its efficacy [38]. Others have considered whether the acidic pH of the solutions was partly responsible for its toxicity.…”

Section: Discussionmentioning

confidence: 99%

Bupivacaine and Triamcinolone May Be Toxic To Human Chondrocytes: A Pilot Study

Syed¹,

Green²,

Bianski³

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Intraarticular injections of corticosteroids combined with local anesthetics are commonly used for management of chronic pain symptoms associated with degenerative joint diseases and after arthroscopic procedures. Several studies suggest chondrotoxicity of local anesthetics whereas others report chondroprotective and cytotoxic effects of corticosteroids on cartilage. Given the frequency of use of these agents, it is important to know whether they are in fact toxic. Questions/purposes We asked whether (1) bupivacaine and triamcinolone acetonide, alone and combined, were chondrotoxic to chondrocytes in culture; (2) buffering of the reagents diminished toxicity of the bupivacaine and triamcinolone; and (3) the presence of the superficial layer of articular cartilage protects against toxicity. Materials and Methods We obtained cartilage from three patients undergoing arthroplasty. To address triamcinolone acetonide, bupivacaine, and combinatorial toxicity to human chondrocytes, we set up monolayer chondrocyte cultures (n = 8 wells per condition). The question of buffering was addressed by performing the same assays as above, but the reagents were buffered. An MTT assay was used to assess chondrocyte survival in the monolayer. We harvested 21 articular plugs from each of three patients (total 63 plugs) and exposed them to the same reagents as above, including the buffered reagents. A Live/Dead assay was used to determine chondrocyte survival. Results Triamcinolone acetonide, bupivacaine, and their combination were toxic to human chondrocytes in the monolayer comparisons. The addition of buffering did not mitigate chondrocyte death. With the intact superficial layer in the plug group, bupivacaine was not toxic as compared with for the control group; all the other reagents (triamcinolone, combination bupivacaine/triamcinolone, buffered bupivacaine, buffered triamcinolone, and buffered combination) produced chondrotoxicity. Conclusions Triamcinolone induced chondrotoxicity in the articular plug and monolayer culture, whereas bupivacaine induced chondrotoxicity only in monolayer culture. The combined used of triamcinolone and bupivacaine did not show additive chondrocyte death in any arm. Buffering of bupivacaine increased its chondrotoxicity. Clinical Relevance Although not necessarily reflecting in vivo conditions, our data suggest physicians should be cognizant of the potential in vitro chondrotoxicity of bupivacaine and triamcinolone when contemplating intraarticular administration.

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Section: Discussionmentioning

confidence: 99%

Bupivacaine and Triamcinolone May Be Toxic To Human Chondrocytes: A Pilot Study

Syed¹,

Green²,

Bianski³

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…Este mecanismo produz uma aceleração do efeito anestésico e redução da dor durante a picada. 28 A associação de adrenalina numa concentração de 1:200 000 à solução de anestésico provoca vasoconstrição local e diminuição da sua absorção sistémica, que se traduz num aumento da intensidade e duração da anestesia. 29 …”

Section: Definição E Mecanismos De Perceção Da Dorunclassified

Abordagem da Dor em Dermatologia (Parte I)

Duarte

Roberto

Cruz

et al. 2018

SPDV

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RESUMO -A dor é um sintoma universal em Medicina e, na Dermatovenereologia, é transversal ao domínio médico e cirúrgico da especialidade. O controlo da dor aguda peri-operatória é um indicador de qualidade dos cuidados de saúde, sendo um fator determinante de morbilidade e de satisfação do doente. O tratamento pouco eficaz da dor crónica tem repercussões significativas na qualidade de vida e a nível socioeconómico. Esta revisão contempla os princípios gerais do tratamento da dor aguda peri-operatória e da dor crónica em Dermatovenereologia. Pretende-se sensibilizar para a importância da dor e contribuir para a redução da dor não controlada e a humanização dos cuidados prestados ao doente dermatológico. Nesta primeira parte da revisão, são abordados os aspetos epidemiológicos, a definição e o modelo conceptual atual para a compreensão da dor, bem como os fundamentos do tratamento da dor aguda peri-operatória. PALAVRAS-CHAVE -Dermatologia; Doenças da Pele; Dor; Medição da Dor; Procedimentos Cirúrgicos Dermatológicos; Tratamento da Dor. Pain Management in Dermatology (Part I) ABSTRACT -Pain is a major clinical symptom in medicine. In the scope of Dermatology, pain occurs most commonly in the surgical setting, but it is also associated with a wide spectrum of chronic medical entities. Control of acute perioperative

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“…Selain efek pH obat, ukuran jarum, suhu, dan kecepatan penyuntikan obat anestesi lokal juga memengaruhi nyeri yang ditimbulkan saat infiltrasi anestesi lokal. 4,5,9 Nakayama dkk. 7 telah menyatakan bahwa tindakan alkalinisasi pada lidokain HCl dengan cara menambahkan natrium bikarbonat 8,4% dengan perbandingan pengenceran 1:10 akan mengubah pH mendekati pH jaringan tubuh tanpa risiko terjadinya presipitasi pada obat anestesi lokal serta lebih stabil.…”

Section: Pembahasanunclassified

“…Seberapa banyak natrium bikarbonat dapat ditambahkan ke dalam anestetik lokal tidak terdapat patokan yang pasti, namun pada dosis yang sering dipakai telah dapat meningkatkan pH solusi mendekati pH jaringan. 4,5,11,12 Semua data pada penelitian menunjukkan efek alkalinisasi lidokain HCl 2% bermakna untuk mengurangi nyeri saat infiltrasi serta saat insersi jarum epidural. Hal ini disebabkan peningkatan nilai pH dari lidokain HCl 2% yang dialkalinisasi sehingga mendekati pH tubuh.…”

Section: Pembahasanunclassified

Penambahan Natrium Bikarbonat 8,4% pada Lidokain 2% untuk Mengurangi Nyeri Saat Infiltrasi Anestetik Lokal

Rahmansyah¹,

Nawawi²,

Pradian³

2014

jap

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AbstrakInfiltrasi anestesi lokal di daerah penyuntikan jarum epidural menggunakan lidokain menimbulkan nyeri. Penelitian ini bertujuan untuk mengetahui keefektifan penambahan natrium bikarbonat 8,4% pada lidokain HCl 2% dengan perbandingan 1:10 untuk mengurangi nyeri saat infiltrasi. Penelitian dilakukan pada bulan Juni hingga Juli 2013 di Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung. Penelitian dilakukan dengan uji klinis acak tersamar ganda pada 44 pasien yang menjalani operasi dengan teknik anestesi epidural. Subjek dibagi 2 kelompok, kelompok eksperimen (LB) mendapatkan infiltrasi lidokain HCl 2% alkalin dengan menambahkan natrium bikarbonat 8,4% dengan perbandingan 1:10, kelompok kontrol (L) mendapatkan lidokain HCl 2%. Pada kedua kelompok dinilai numeric rating scale (NRS) saat infiltrasi lidokain HCl 2%. Hasil penelitian diuji dengan uji chi-kuadrat, uji-t, dan Uji Mann-Whitney, tingkat kepercayaan 95% dan kekuatan uji 94%, dianggap bermakna bila nilai p<0,05. Analisis statistik menunjukkan perbedaan bermakna nilai median NRS pada kelompok eksperimen dengan kelompok kontrol saat infiltrasi anestesi lokal (5 vs 3), dengan nilai rentang (3-6 vs 1-4) dengan nilai p<0,05. Simpulan penelitian ini adalah alkalinisasi lidokain HCl 2% dengan penambahan natrium bikarbonat 8,4% dengan perbandingan 1:10 mempunyai efek mengurangi nilai NRS.Kata kunci: Alkalinisasi, lidokain HCl 2%, natrium bikarbonat 8,4% Addition of 8.4% Sodium Bicarbonate to 2% Lidocaine in ReducingPain During Local Anaesthetic Infiltration AbstractLocal anesthetic infiltration in the area of epidural injections using lidocaine can cause pain. This research was done in June-July 2013, in Dr. Hasan Sadikin Hospital, to determine the effectiveness of adding 8.4% sodium bicarbonate to lidocaine HCl 2 % with 1:10 ratio. This was a double-blind randomized control study involving 44 patients undergoing surgery with epidural techniques. Subjects were divided into two groups, the experimental group (LB) was given 2% lidocaine HCl with sodium bicarbonate 8.4% 1:10 ratio as a local anestetich while the control group (L) was given lidocaine 2%. Numeric rating scale (NRS) was assessed during infiltration. Data was analyzed using chi-squere test, t-test and Mann-Whitney Test, with 95% confidence level and 94% strength tes and considered significant if p<0.05. Statistical anaylsis showed a significant difrerence in median of NRS in the experiment compared to control group during local anaesthetic infiltration (5 versus 3), with range of 3-6 versus 1-4 with p>0.05. In conclusion, alkalinization of 2% lidocaine HCl by addition of 8.4% sodium bicarbonate with 1:10 ratio has an effect in reducing NRS.

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Buffering the pain of local anaesthetics: A systematic review

Cited by 73 publications

References 55 publications

Bupivacaine and Triamcinolone May Be Toxic To Human Chondrocytes: A Pilot Study

Bupivacaine and Triamcinolone May Be Toxic To Human Chondrocytes: A Pilot Study

Abordagem da Dor em Dermatologia (Parte I)

Penambahan Natrium Bikarbonat 8,4% pada Lidokain 2% untuk Mengurangi Nyeri Saat Infiltrasi Anestetik Lokal

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