Efficacy of Bicarbonate in Decreasing Pain on Intradermal Injection of Local Anesthetics

Hanna, Marie N.; Elhassan, Amir; Veloso, Patricia M.; Lesley, Maggie R.; Lissauer, Jon; Richman, Jeffrey M.; Wu, Christopher L.

doi:10.1097/aap.0b013e31819a12a6

Cited by 53 publications

(44 citation statements)

References 27 publications

(7 reference statements)

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“…Systematic reviews in medicine have shown reduced injection pain with buffered anesthetics (17)(18)(19). In dentistry, some authors have shown decreased injection pain with buffered lidocaine (8,9,13,15,20), whereas others have not shown a decrease (7,10,12,16,21,22).…”

Section: Discussionmentioning

confidence: 96%

“…Regarding the onset of anesthesia, some authors (8,9,(13)(14)(15) have found a faster onset with buffered lidocaine formulations, whereas others have not (7,16). Systematic reviews in medicine have shown reduced injection pain with buffered anesthetics (17)(18)(19). The rationale is that the higher pH of buffered anesthetics (pH of 7.6 in the current study) is not as acidic as standard cartridges of lidocaine (pH of 4.8 in the current study), theoretically causing less pain during injection (7).…”

mentioning

confidence: 97%

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Buffered 4% Articaine as a Primary Buccal Infiltration of the Mandibular First Molar: A Prospective, Randomized, Double-blind Study

Shurtz¹,

Nusstein

Reader

et al. 2015

Journal of Endodontics

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Section: Discussionmentioning

confidence: 96%

mentioning

confidence: 97%

Buffered 4% Articaine as a Primary Buccal Infiltration of the Mandibular First Molar: A Prospective, Randomized, Double-blind Study

Shurtz¹,

Nusstein

Reader

et al. 2015

Journal of Endodontics

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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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“…A majority of investigations in medicine have shown reduced injection pain with buffered anesthetics (1)(2)(3). In dentistry, authors have shown decreased injection pain with buffered lidocaine (4)(5)(6)(7)(8), whereas others have not shown a decrease (9)(10)(11)(12).…”

mentioning

confidence: 98%

Effect of Buffered 4% Lidocaine on the Success of the Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis: A Prospective, Randomized, Double-blind Study

Schellenberg¹,

Drum

Reader

et al. 2015

Journal of Endodontics

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Efficacy of Bicarbonate in Decreasing Pain on Intradermal Injection of Local Anesthetics

Abstract: Our systematic review suggests that the use of buffered local anesthetics seems to be associated with a statistical decrease in pain of infiltration when compared with unbuffered local anesthetic.

Cited by 53 publications

References 27 publications

Buffered 4% Articaine as a Primary Buccal Infiltration of the Mandibular First Molar: A Prospective, Randomized, Double-blind Study

Buffered 4% Articaine as a Primary Buccal Infiltration of the Mandibular First Molar: A Prospective, Randomized, Double-blind Study

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

Effect of Buffered 4% Lidocaine on the Success of the Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis: A Prospective, Randomized, Double-blind Study

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