Pain reduction in local anesthetic administration through pH buffering

Christoph, Richard A.; Buchanan, Leslie; Begalla, Kimberly; Schwartz, Steven O.

doi:10.1016/s0196-0644(88)80293-2

Cited by 270 publications

(130 citation statements)

References 5 publications

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“…DiFazio et al, 16 Zahl et al, 17 Benson et al, 18 and Sinnott et al 19 found that anesthetic formulations with higher pH values had a faster onset. However, Galindo et al 15 and Christoph et al 34 did not find pH-adjusted agents to have a faster onset. It would seem that the higher pH^adjusted anesthetic formulations would have more of the uncharged base available initially.…”

Section: Discussionmentioning

confidence: 94%

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A Prospective, Randomized, Double-Blind Study of the Anesthetic Efficacy of Sodium Bicarbonate Buffered 2% Lidocaine With 1 : 100,000 Epinephrine in Inferior Alveolar Nerve Blocks

Whitcomb¹,

Drum

Reader

et al. 2010

Anesthesia Progress

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The authors, using a crossover design, randomly administered, in a double-blind manner, inferior alveolar nerve ( IAN ) blocks using a buffered 2% lidocaine with 1 : 100,000 epinephrine/sodium bicarbonate formulation and an unbuffered 2% lidocaine with 1 : 100,000 epinephrine formulation at 2 separate appointments spaced at least 1 week apart. An electric pulp tester was used in 4-minute cycles for 60 minutes to test for anesthesia of the first and second molars, premolars, and lateral and central incisors. Anesthesia was considered successful when 2 consecutive 80 readings were obtained within 15 minutes, and the 80 reading was continuously sustained for 60 minutes. For the buffered 2% lidocaine with 1 : 100,000 epinephrine/sodium bicarbonate formulation, successful pulpal anesthesia ranged from 10^71%. For the unbuffered 2% lidocaine with 1 : 100,000 epinephrine formulation, successful pulpal anesthesia ranged from 10^72%. No significant differences between the 2 anesthetic formulations were noted. The buffered lidocaine formulation did not statistically result in faster onset of pulpal anesthesia or less pain during injection than did the unbuffered lidocaine formulation. We concluded that buffering a 2% lidocaine with 1 : 100,000 epinephrine with sodium bicarbonate, as was formulated in the current study, did not statistically increase anesthetic success, provide faster onset, or result in less pain of injection when compared with unbuffered 2% lidocaine with 1 : 100,000 epinephrine for an IAN block.

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Section: Discussionmentioning

confidence: 94%

“…Using an intradermal injection model, Christoph et al 34 and McKay et al 37 found that buffered anesthetic solutions with sodium bicarbonate significantly decreased the pain of injection. However, Gershon et al 38 and Burns et al 39 found no significant pain reduc- À Teeth with failures were excluded from the onset of pulpal anesthesia.…”

Section: Discussionmentioning

confidence: 99%

A Prospective, Randomized, Double-Blind Study of the Anesthetic Efficacy of Sodium Bicarbonate Buffered 2% Lidocaine With 1 : 100,000 Epinephrine in Inferior Alveolar Nerve Blocks

Whitcomb¹,

Drum

Reader

et al. 2010

Anesthesia Progress

View full text Add to dashboard Cite

show abstract

“…Few studies have examined the effect of buffering lidocaine on the duration of anesthesia. Christoph et al (13) concluded that buffering did not affect the duration of effect of lidocaine or mepivacaine. A discussion of the pharmacokinetics is beyond the scope of the present article.…”

Section: Discussionmentioning

confidence: 99%

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

Afolabi¹,

Murphy²,

Chung³

et al. 2013

CAN J PLAST SURG

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“…Buffering the usually acidic lidocaine hydrochloride (pH ϭ 6.5) dramatically shortens its shelf life, thus the recommendation to add the buffer solution just before its use. 36 Unfortunately, the infants in the study did not seem to respond to this technique as did the adults, thus reflecting the difficulty in extrapolating from the adult pain experience. Any physician or nurse who has attempted to extend the arms and legs of a term neonate to strap them into a rigid restraint, realizes the resistance to extension that all neonates possess.…”

Section: Discussionmentioning

confidence: 95%

Beyond Dorsal Penile Nerve Block: A More Humane Circumcision

et al. 1997

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ABSTRACT. Objective. To explore techniques that can be utilized in addition to the dorsal penile nerve block (DPNB) to further reduce the neonate's stress and pain from routine circumcision, and thus make the procedure more humane.Setting. Level 1 nursery at a community hospital. Subjects. Eighty healthy, term, newborn male infants scheduled for routine neonatal circumcision.Study Design. Prospective and randomized; double blind and placebo controlled for the study solutions.Methods. Four statistically similar groups of 20 were studied. The control group included infants circumcised using: a) a rigid plastic restraint board; b) standard DPNB; and c) a pacifier dipped in water to comfort the infant. Each study group differed from the controls in one variable including: 1) using a specially designed, physiologic circumcision restraint chair; 2) pH buffering of lidocaine hydrochloride used for DPNB; and 3) offering a pacifier dipped in a 24% sucrose solution during the DPNB and circumcision. Behavioral observations were recorded and compared for each group starting before the injection of lidocaine hydrochloride and continuing through the completion of the circumcision. Plasma for cortisol levels were collected 30 minutes after the circumcision.Results. Neonates circumcised on the new restraint chair showed a significant decrease in distress scores (>50%) compared with the control group on the rigid molded-plastic restraint. The pacifier dipped in sucrose had a distress-reducing effect during both the post-DPNB injection and circumcision periods. The infants who were injected with the buffered lidocaine showed no differences in distress from the controls. The plasma cortisol levels were not significantly affected by any additional technique and were comparable to the levels previously reported.Conclusions. When neonatal circumcisions are performed routinely, they should be done as humanely as possible. This study demonstrates that, when used in conjunction with DPNB, a pacifier dipped in 24% sucrose and a more comfortable, padded, and physiologic restraint can be useful in decreasing distress and pain. Pediatrics 1997;100(2). URL: http://www.pediatrics.org/ cgi/content/full/100/2/e3; dorsal penile nerve block, circumcision, neonatal pain.ABBREVIATIONS. DPNB, dorsal penile nerve block; EMLA, eutectic mixture of local anesthetics; GHI, Group Health, Inc.; ANOVA, analysis of variance. R outine neonatal circumcision, when performed without anesthesia, is a painful and stressful operation.

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Pain reduction in local anesthetic administration through pH buffering

Cited by 270 publications

References 5 publications

A Prospective, Randomized, Double-Blind Study of the Anesthetic Efficacy of Sodium Bicarbonate Buffered 2% Lidocaine With 1 : 100,000 Epinephrine in Inferior Alveolar Nerve Blocks

A Prospective, Randomized, Double-Blind Study of the Anesthetic Efficacy of Sodium Bicarbonate Buffered 2% Lidocaine With 1 : 100,000 Epinephrine in Inferior Alveolar Nerve Blocks

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

Beyond Dorsal Penile Nerve Block: A More Humane Circumcision

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