Neutralized Lidocaine with Epinephrine for Local Anesthesia

Stewart, James; Cole, Gary W.; Klein, Jeffrey A.

doi:10.1111/j.1524-4725.1989.tb03127.x

Cited by 125 publications

(65 citation statements)

References 10 publications

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“…8 Addition of sodium bicarbonate to the lignocaine solution has been shown to reduce pain during infiltration. 7,8 However, its use in this study did not improve infiltration pain scores. The most likely explanation is that the prior application of EMLA to all donors had created adequate surface anaesthesia.…”

Section: Discussionmentioning

confidence: 54%

“…1,6 Various studies have demonstrated that adding a small amount of 8.4% sodium bicarbonate to the LA solution can significantly reduce such pain. 7,8 In addition, a eutectic mixture of local anaesthetics (EMLA, Astra, Södertälje, Sweden) cream is also an effective cutaneous anaesthetic, 9,10 although there is no previous experience reported in the literature on the combined use of EMLA and alkalinized LA in attenuating the pain associated with LA infiltration. Therefore, in an attempt to improve the comfort level of our donors, we conducted a study to investigate the clinical advantage of alkalinized LA in the presence of EMLA among donors undergoing posterior iliac crests BMH procedures using PCA-A.…”

mentioning

confidence: 99%

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Bone marrow harvesting using EMLA (eutectic mixture of local anaesthetics) cream, local anaesthesia and patient-controlled analgesia with alfentanil

Sim

1999

Bone Marrow Transplant

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Summary:Bone marrow harvesting (BMH) was performed on 40 consecutive allogeneic or autologous donors using EMLA (eutectic mixture of local anaesthetics), local anaesthesia (LA) and patient-controlled analgesia with alfentanil (PCA-A). The effect of alkalinizing the LA solution on reducing pain during LA infiltration in the presence of EMLA was also investigated. EMLA 10 g with occlusive dressing was applied to the harvest sites at least 60 min before BMH. The PCA device was programmed to deliver an intravenous loading dose of 15 g/kg alfentanil, followed by a background alfentanil infusion of 0.05 g/kg/min. Demand dose was 4 g/kg and lockout time was 3 min. Donors were randomized to receive either alkalinized (n = 19) or non-alkalinized (n = 21) LA solution (lignocaine 1% with 1:100 000 adrenaline). While post-operative nausea and vomiting were the only side-effects, all donors in both groups reported satisfactory pain scores during LA infiltration and satisfactory overall intra-operative comfort scores. They completed BMH using either regimen successfully, found this technique acceptable and would recommend this form of anaesthesia to others. Alkalinizing the LA solution did not significantly improve the pain scores during LA infiltration in the presence of EMLA. In conclusion, BMH can be performed safely using EMLA, LA and PCA-A without major complications.

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Section: Discussionmentioning

confidence: 54%

mentioning

confidence: 99%

Bone marrow harvesting using EMLA (eutectic mixture of local anaesthetics) cream, local anaesthesia and patient-controlled analgesia with alfentanil

Sim

1999

Bone Marrow Transplant

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“…Commercial preparations of lidocaine and epinephrine have an acidic pH between 3.5 and 7.0 to promote epinephrine stability [43,44]. In a recent Cochrane review, pain associated with the infiltration of buffered lidocaine was significantly less than the pain of unbuffered lidocaine.…”

Section: Bicarbonatementioning

confidence: 98%

Local Anesthesia: Evidence, Strategies, and Safety

et al. 2015

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The number of office-based procedures performed utilizing local anesthesia continues to rise, particularly in dermatologic settings. As more emphasis is placed on cost effectiveness in medicine, it is important to understand the role that office-based procedures can play in providing excellent dermatologic care. In addition, it is essential to continually demonstrate that local anesthesia administered in office-based settings is safe and effective in order to maintain a high standard of care within the specialty. Achieving adequate local anesthesia is imperative to ensure patient comfort, reduce anxiety, and promote optimal outcomes. The clinician should have a comprehensive understanding of the pathophysiology, mechanism of action, practical applications and techniques, and potential adverse events of various topical and injectable anesthetics in order to enhance patient satisfaction and safety. Lidocaine, which is the most commonly used local anesthetic, has a rapid onset, moderate duration, and excellent safety profile, making it a staple in office-based procedures.

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“…22 This is advantageous in diminishing the pain of injection and also because it leaves less ionized lidocaine outside the cell for uptake. 23 However, altering the pH of the solution has the potential for changing the effectiveness of the epinephrine. Warmed and room-temperature injectate have been used.…”

Section: Solution Of the Total (1000 Ml)mentioning

confidence: 99%