Changing the Buffer in Buffered Lidocaine

Abstract

Hospitalized patients require venous access for procedures, treatments, or therapies. The use of lidocaine for pain relief during central vascular access device (CVAD) insertion is a standard of practice. Lidocaine buffered with sodium bicarbonate has been shown to provide significantly more pain relief in the sensation of pain upon injection. Shortages of lidocaine with bicarbonate provided an opportunity to explore other options to provide pain relief during CVAD insertion. The PICO question for this project was: In adult patients requiring CVAD insertion, how does lidocaine buffered with bicarbonate compare with lidocaine buffered with saline in minimizing pain with lidocaine injection? This study assessed how lidocaine buffered with bicarbonate compares with lidocaine buffered with saline in minimizing pain with lidocaine injection. Sixty patients received the buffered lidocaine before having a peripherally inserted central catheter inserted. Thirty patients received lidocaine buffered with bicarbonate and 30 patients received lidocaine buffered with saline. Pain and vasoconstriction were the 2 outcomes monitored during the project. Although the trial was only 2 wk due to the urgency of the rollout, the pilot was able to offer clinicians the opportunity to compare the 2 products. The saline-buffered lidocaine provided comparable pain relief compared with the lidocaine buffered with bicarbonate. The clinicians also measured the amount of vasoconstriction caused by the 2 products with similar outcomes.

Strategies to minimize procedure-related pain and anxiety: lessons from pediatric dermatology

“…Raising the pH of injectable anesthetic, most commonly with sodium bicarbonate, has more consistently been found to significantly decrease pain scores [38 ▪ ,39]. Interestingly, a recent study found that buffering lidocaine with normal saline was equally effective to buffering with sodium bicarbonate [40].…”