Buffered lidocaine 1%/epinephrine 1:100,000 with sodium bicarbonate (sodium hydrogen carbonate) in a 3:1 ratio is less painful than a 9:1 ratio: A double-blind, randomized, placebo-controlled, crossover trial.,Journal of the American Academy of Dermatology

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Buffered lidocaine 1%/epinephrine 1:100,000 with sodium bicarbonate (sodium hydrogen carbonate) in a 3:1 ratio is less painful than a 9:1 ratio: A double-blind, randomized, placebo-controlled, crossover trial.
Journal of the American Academy of Dermatology ( IF 13.8 ) Pub Date : 2020-01-17 , DOI: 10.1016/j.jaad.2019.09.088
Alexandra Vent ₁ , Christian Surber ₁ , Nicole Tracy Graf Johansen ₂ , Verena Figueiredo ₃ , Georg Schönbächler ₄ , Laurence Imhof ₁ , Caroline Buset ₁ , Jürg Hafner ₁

Affiliation

Background

Neutralizing (buffering) lidocaine 1%/epinephrine 1:100,000 solution (Lido/Epi) with sodium hydrogen carbonate (NaHCO₃) (also called sodium bicarbonate) is widely used to reduce burning sensations during infiltration of Lido/Epi. Optimal mixing ratios have not been systematically investigated.

Objectives

To determine whether a Lido/Epi:NaHCO₃ mixing ratio of 3:1 (investigational medicinal product 1) causes less pain during infiltration than a mixing ratio of 9:1 (IMP2) or unbuffered Lido/Epi (IMP3).

Methods

Double-blind, randomized, placebo-controlled, crossover trial (n = 2 × 24) with 4 investigational medicinal products (IMP1-4).

Results

The 3:1 mixing ratio was significantly less painful than the 9:1 ratio (P = .044). Unbuffered Lido/Epi was more painful than the buffered Lido/Epi (P = .001 vs IMP1; P = .033 vs IMP2). IMP4 (NaCl 0.9% [placebo]) was more painful than any of the anesthetic solutions (P = .001 vs IMP1; P = .001 vs IMP2; P = .016 vs IMP3). In all cases, the anesthesia was effective for at least 3 hours.

Limitations

Results of this trial cannot be generalized to other local anesthetics such as prilocaine, bupivacaine, or ropivacaine, which precipitate with NaHCO₃ admixtures.

Conclusions

Lido/Epi-NaHCO₃ mixtures effectively reduce burning pain during infiltration. The 3:1 mixing ratio is significantly less painful than the 9:1 ratio. Reported findings are of high practical relevance, given the extensive use of local anesthesia today.

中文翻译：

缓冲利多卡因 1%/肾上腺素 1:100,000 与碳酸氢钠（碳酸氢钠）以 3:1 的比例比 9:1 的比例更痛：一项双盲、随机、安慰剂对照、交叉试验。

背景

中和（缓冲）利多卡因 1%/肾上腺素 1:100,000 溶液（Lido/Epi）与碳酸氢钠 (NaHCO ₃ )（也称为碳酸氢钠）被广泛用于减少 Lido/Epi 浸润过程中的烧灼感。尚未系统地研究最佳混合比。

目标

确定3:1的 Lido/Epi:NaHCO ₃混合比（研究性药物产品 1）是否比混合比 9:1 (IMP2) 或无缓冲的 Lido/Epi (IMP3) 引起的浸润疼痛更小。

方法

双盲、随机、安慰剂对照、交叉试验（n = 2 × 24），涉及 4 种研究药物（IMP1-4）。

结果

3:1 混合比例比 9:1 比例显着减轻疼痛 ( P = .044)。无缓冲的 Lido/Epi 比缓冲的 Lido/Epi 更痛（P = .001 vs IMP1；P = .033 vs IMP2）。IMP4（NaCl 0.9% [安慰剂]）比任何麻醉剂溶液都更痛（P = .001 vs IMP1；P = .001 vs IMP2；P = .016 vs IMP3 ）。在所有情况下，麻醉至少有效 3 小时。