The Effects of Warming and Buffering on Pain of Infiltration of Lidocaine

Bartfield, Joel M.; Crisafulli, Kathleen M.; Raccio‐Robak, Nancy; Salluzzo, Richard F

doi:10.1111/j.1553-2712.1995.tb03218.x

Cited by 53 publications

(51 citation statements)

References 10 publications

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“…Whereas a multitude of investigators have championed other techniques such as altering the rate of infiltration [14,36], distraction methods, buffering [16-19, 37, 38] and warming the anaesthetic agents [39][40][41][42] in a variety of settings, there is no clear consensus as to the best method to reduce infiltrative pain, as no-one has sought to combine all these techniques in a prospective randomised study. Some studies have demonstrated that warm buffered anaesthetic agents induce less pain during infiltration than either warmed or buffered agents used in isolation, and that buffering solutions is preferable to warming the anaesthetic agents [9,12,13]. However, it is difficult to make comparisons between these studies as considerable heterogeneity exists in the volume of infiltrate, the technique and anatomical location of infiltration, and the method of warming and buffering procedures.…”

Section: Discussionmentioning

confidence: 99%

“…The infiltration of local anaesthesia is the most painful part of such procedures and pain associations quickly develop into avoidance behaviours, with implications for future procedures [6][7][8]. Anxiety induced by preceding infiltrative pain is counterproductive [9].…”

mentioning

confidence: 99%

“…These include application of topical analgesics such as amethocaine [10], distraction techniques [11], counter irritation [12], warming the anaesthetic agents [13], varying rates of infiltration [14] and buffering the local anaesthesia [9,[15][16][17][18][19].…”

mentioning

confidence: 99%

See 2 more Smart Citations

The effect of local cooling on pain perception during infiltration of local anaesthetic agents, a prospective randomised controlled trial*

Leff

Nortley²,

Dang³

et al. 2007

Anaesthesia

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SummaryThe effect of pre‐infiltration local cooling of the site of inguinal herniorrhaphy on pain perception during infiltration of local anaesthetic was studied in a prospective randomised controlled trial. One hundred patients were randomly allocated to receive topical application of either a cooled saline bag (study group) or a saline bag at room temperature (control group) prior to injection of local anaesthetic. Pain scores were recorded using a visual analogue scale following application of the saline bags and again on completion of infiltration with local anaesthetic. There was no significant difference in pain scores following topical saline bag application. However, a highly significant difference (p = 0.0001, Mann–Whitney U) was observed between post‐infiltration pain scores of the study group (median = 2) and the control group (median = 6).

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The effect of local cooling on pain perception during infiltration of local anaesthetic agents, a prospective randomised controlled trial*

Leff

Nortley²,

Dang³

et al. 2007

Anaesthesia

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“…113 Injected local anesthetics may be required for additional anesthesia. Methods to decrease pain and distress from injection of local anesthetics include keeping needles out of sight of the child (especially the large-gauge needle used to draw up the anesthetic), buffering lidocaine with sodium bicarbonate in a 9:1 ratio, 114,115 warming the local anesthetic, 115 using a small-gauge needle (27 to 30 gauge), 116 injecting slowly, 117 injecting from wound edges rather than through intact skin, 118 and counterirritating surrounding skin during the injection. 119 Mixing bupivacaine with lidocaine or using lidocaine with epinephrine (except where contraindicated) increases the duration of anesthesia.…”

Section: Pharmacologic Interventionsmentioning

confidence: 99%

Pediatric procedural pain

Young¹

2005

Annals of Emergency Medicine

273

233

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“…It is interesting to note that much of the existing literature regarding the buffering of lidocaine to reduce pain involves lidocaine solutions without epinephrine (13)(14)(15)(16)(17)(18)(19). The addition of epinephrine and the necessary preservatives decreases the pH of the solution and, therefore, increases the potential beneficial effect of buffering (13,14,20,21).…”

Section: (3) Error Bars Represent 95% Cismentioning

confidence: 99%

How acidic is the lidocaine we are injecting, and how much bicarbonate should we add?

Frank

Lalonde

2012

Canadian Journal of Plastic Surgery

118

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T he infiltration of local anesthetics can be painful, and some of this pain may be attributed to the acidity of the anesthetic solution (1). In spite of the fact that a Cochrane study recommended buffering lidocaine with bicarbonate to decrease the pain of injection (2), the use of bicarbonate with lidocaine has only been adopted by a minority of practicing surgeons.One of the possible reasons that surgeons do not use buffered lidocaine is that most hospital pharmacies only premix bicarbonate and lidocaine without epinephrine, which is not as useful as buffered solutions containing epinephrine. In addition, there is a lack of knowledge about how exactly one is required to mix bicarbonate with the local anesthetic and what ratio of the mixture is ideal.The present study aimed to measure the pH of commonly used lidocaine-containing anesthetic agents available at our institutions and to validate the proper concentration of bicarbonate that should be added to lidocaine with epinephrine to neutralize its pH. The present article also aims to generate awareness among surgeons about how simple and inexpensive it is to mix bicarbonate with lidocaine to eliminate the acidity-related pain of local anesthetic injection. MethodsCommercially available solutions of 1% and 2% lidocaine, with and without epinephrine 1:100,000 were obtained (AstraZeneca Inc, Canada; Alveda Pharma, Canada). These were collected from various settings throughout a tertiary care institution (Dalhousie University, Halifax, Nova Scotia; Saint John, New Brunswick) to capture the possible effects of prolonged storage, previously opened bottles or improper storage conditions, to simulate true clinical use conditions. A total of 200 samples were collected (50 samples of each solution) from a variety of lots and ranging in expiration dates. Note was made of whether each multiuse vial was factory sealed or had been opened previously. The pH of each sample was measured using a temperaturecompensating pH meter (Model 98128, Hanna Instruments, Canada) with a resolution of 0.01 and a mean (± SD) accuracy ±0.05.To determine the proper concentration of bicarbonate for neutralization, additional samples of 1% lidocaine with 1:100,000 epinephrine were obtained, along with samples of 8.4% sodium bicarbonate (Hospira, Canada). Ten samples of each were collected. Aliquots of sodium bicarbonate (0.5 mL) were added to 20 mL of lidocaine and BaCkGround: The infiltration of local anesthetics can be painful, which is likely due, in part, to their acidity. In spite of a Cochrane study that recommended neutralizing lidocaine with bicarbonate to decrease the pain of injection, not many surgeons have adopted the practice, and there are many 'recipes' for how much bicarbonate one should add. oBJeCtIVe: To determine the acidity of lidocaine and the correct ratio of bicarbonate that should be added to neutralize lidocaine to achieve body pH. Methods: Fifty samples each of commonly used anesthetics (lidocaine 1% and 2%, with and without epinephrine 1:100,000) were obtained and tes...

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The Effects of Warming and Buffering on Pain of Infiltration of Lidocaine

Abstract: To reduce the pain of lidocane infiltration, buffering is more effective than warming. Warming does not enhance buffering.

Cited by 53 publications

References 10 publications

The effect of local cooling on pain perception during infiltration of local anaesthetic agents, a prospective randomised controlled trial*

The effect of local cooling on pain perception during infiltration of local anaesthetic agents, a prospective randomised controlled trial*

Pediatric procedural pain

How acidic is the lidocaine we are injecting, and how much bicarbonate should we add?

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