Systematic Review and Meta-analysis of the Effect of Warming Local Anesthetics on Injection Pain

Hogan, Mary‐Ellen; vanderVaart, Sondra; Perampaladas, Kumar; Machado, Márcio; Einarson, Thomas R.; Taddio, Anna

doi:10.1016/j.annemergmed.2010.12.001

Cited by 103 publications

(74 citation statements)

References 49 publications

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“…Smaller needle sizes, perpendicular needle angle to the skin, slower speed of injection and warming the solution are all factors that decrease the pain of injection (1,(5)(6)(7).…”

Section: Discussionmentioning

confidence: 99%

The effect of buffering on pain and duration of local anesthetic in the face: A double-blind, randomized controlled trial

Afolabi

Murphy

Chung

et al. 2013

Canadian Journal of Plastic Surgery

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Background The acidity of lidocaine preparations is believed to contribute to the pain of local anesthetic injection. Objective To investigate the effect of buffering lidocaine on the pain of injection and duration of anesthetic effect. Methods A double-blind, randomized trial involving 44 healthy volunteers was conducted. The upper lip was injected with a solution of: lidocaine 1% (Xylocaine, AstraZeneca, Canada, Inc) with epinephrine; and lidocaine 1% with epinephrine and 8.4% sodium bicarbonate. Volunteers reported pain of injection and duration of anesthetic effect. Results Twenty-six participants found the unbuffered solution to be more painful. Fifteen participants found the buffered solution to be more painful; the difference was not statistically significant. Twenty-one volunteers reported duration of anesthetic effect. The buffered solution provided longer anesthetic effect than the unbuffered solution (P=0.004). Conclusion Although buffering increased the duration of lidocaine's anesthetic effect in this particular model, a decrease in the pain of the injection was not demonstrated, likely due to limitations of the study.

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“…Smaller needle sizes, perpendicular needle angle to the skin, slower speed of injection and warming the solution are all factors that decrease the pain of injection (1,(5)(6)(7).…”

Section: Discussionmentioning

confidence: 99%

The effect of buffering on pain and duration of local anesthetic in the face: A double-blind, randomized controlled trial

Afolabi

Murphy

Chung

et al. 2013

Canadian Journal of Plastic Surgery

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“…Respondents who used refrigeration-only GH products spent a large proportion of the injection time waiting for product to reach room temperature, which may have contributed to the relatively large proportion of respondents who admitted to regularly skipping warm-up entirely. Colder preparations injected subcutaneously are associated with increased pain [14]. If patients using refrigeration-only products skipped the warming-up process, this may explain Table 3.…”

Section: Discussionmentioning

confidence: 93%

A web-based survey assessing the impact of storage flexibility on the daily life of patients and caregivers administering growth hormone

Kappelgaard¹,

Metzinger²,

Schnabel³

2015

Expert Review of Medical Devices

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Many growth hormone (GH) products require refrigeration after first use or reconstitution. This may reduce adherence by affecting patients' daily activities. Persistent treatment adherence is essential for effective GH therapy. A web-based survey was used to compare the impact of storage-flexible GH products (stable at room temperature [<25°C] for up to 21 days after first use) with refrigeration-only GH products on patients' and caregivers' daily lives. Compared with refrigeration-only GH products, storage-flexible GH products were associated with shorter injection times, greater adherence, less GH wastage and fewer missed activities due to difficulties with injection, and were the preferred type of GH product. When offered a choice of GH product, the majority of patients chose a storage-flexible product.

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“…This benefit could be even more important when using 1 % lidocaine with epinephrine because this solution is more acidic than 1 % lidocaine alone [139]. Other recommendations to reduce pain at the injection site also include the injection of the solution at body temperature, using a slow injection with a small needle, and within the wound [140]. In younger children, the use of absorbable sutures to close lacerations should be favored as no removal will be required.…”

Section: Lacerationsmentioning

confidence: 95%

Managing Pediatric Pain in the Emergency Department

Bailey

Trottier

2016

Pediatr Drugs

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Far more attention is now given to pain management in children in the emergency department (ED). When a child arrives, pain must be recognized and evaluated using a pain scale that is appropriate to the child's development and regularly assessed to determine whether the pain intervention was effective. At triage, both analgesics and non-pharmacological strategies, such as distraction, immobilization, and dressing should be started. For mild pain, oral ibuprofen can be administered if the child has not received it at home, whereas ibuprofen and paracetamol are suitable for moderate pain. For patients who still require pain relief, oral opioids could be considered; however, many EDs have now replaced this with intranasal fentanyl, which allows faster onset of pain relief and can be administered on arrival pending either intravenous access or definitive care. Intravenous opioids are often required for severe pain, and paracetamol or ibuprofen can still be considered for their likely opioid-sparing effects. Specific treatment should be used for patients with migraine. In children requiring intravenous access or venipuncture, non-pharmacological and pharmacological strategies to decrease pain and anxiety associated with needle punctures are mandatory. These strategies can also be used for laceration repairs and other painful procedures. Despite the gaps in knowledge, pain should be treated with the most up-to-date evidence in children seen in EDs.

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Systematic Review and Meta-analysis of the Effect of Warming Local Anesthetics on Injection Pain

Cited by 103 publications

References 49 publications

The effect of buffering on pain and duration of local anesthetic in the face: A double-blind, randomized controlled trial

The effect of buffering on pain and duration of local anesthetic in the face: A double-blind, randomized controlled trial

A web-based survey assessing the impact of storage flexibility on the daily life of patients and caregivers administering growth hormone

Managing Pediatric Pain in the Emergency Department

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