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Neutralized lidocaine with epinephrine for local anesthesia
J H Stewart1, G W Cole, J A Klein
1Department of Dermatology, University of California, Irvine.
The Journal of Dermatologic Surgery and Oncology
|October 1, 1989
Summary
Adding sodium bicarbonate to lidocaine with epinephrine significantly reduces injection pain. Higher concentrations (40 and 100 meq/L) were more effective than lower ones, though epinephrine stability decreased.
Area of Science:
- Anesthesiology
- Pharmacology
- Pain Management
Background:
- Local anesthetics like lidocaine with epinephrine are widely used for skin infiltration.
- Injection pain is a common patient concern, potentially impacting procedure tolerance.
- Sodium bicarbonate is explored as an additive to buffer local anesthetics.
Purpose of the Study:
- To evaluate the impact of sodium bicarbonate addition on the pain of lidocaine with epinephrine skin infiltration.
- To determine the optimal concentration of sodium bicarbonate for pain reduction.
- To assess the stability of epinephrine in buffered anesthetic solutions.
Main Methods:
- Varied concentrations of sodium bicarbonate (0, 10, 40, 100 meq/L) were added to 1% lidocaine with 1:100,000 epinephrine.
- Pain scores associated with skin infiltration of these solutions were measured.
- Epinephrine concentration stability was assessed in solutions with 100 meq/L sodium bicarbonate at pH 7.3 over time.
Main Results:
- Sodium bicarbonate at 40 and 100 meq/L significantly reduced infiltration pain compared to 0 or 10 meq/L.
- Epinephrine concentration showed a decline of approximately 25% per week in solutions containing 100 meq/L sodium bicarbonate.
Conclusions:
- Sodium bicarbonate effectively reduces the pain of lidocaine with epinephrine skin infiltration.
- While effective for pain, higher sodium bicarbonate concentrations impact epinephrine stability.
- Further research may be needed to balance pain relief and anesthetic efficacy.