Effects of alkalinization of lidocaine on the pain of skin infiltration and intravenous catheterization.
OBJECTIVE
To test the hypothesis that alkalinization of lidocaine decreases the pain of skin infiltration in surgical patients.


METHODS
Double-blind, randomized, prospective study.


METHODS
Preoperative holding units, Brigham and Women's Hospital.


METHODS
184 adult surgical patients.


METHODS
We compared the efficacy of 1% lidocaine with and without 0.1 mEq/ml of sodium bicarbonate (NaHCO3) for relief of pain of (1) skin infiltration and (2) intravenous (i.v.) catheterization prior to surgery.


RESULTS
Patients evaluated the intensity of pain using a 100 mm visual analog scale (VAS). There were no differences between study groups (lidocaine with NaHCO3, n = 89; lidocaine alone, n = 95) with respect to site of catheterization or catheter gauge used. Lidocaine plus NaHCO3 caused significantly less pain on skin infiltration (median VAS = 4; range = 0 to 51) than did lidocaine alone (VAS = 8; range = 0 to 48; p < 0.008). Pain of i.v. catheterization also did not differ between groups. There was a weak correlation between catheter gauge and pain of i.v. catheterization (r = -0.19; p = 0.01).


CONCLUSIONS
Pain resulting from skin infiltration of lidocaine solutions can be diminished by adding NaHCO3. However, catheter size is more important than the presence or absence of NaHCO3 in determining the pain of i.v. catheterization.
Steinbrook
R A
RA
Department of Anesthesia, Brigham and Women's Hospital, Boston, MA 02115.
Hughes
N
N
Fanciullo
G
G
Manzi
D
D
Ferrante
F M
FM
D000328:Adult; D000772:Anesthesia, Local / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation; D004311:Double-Blind Method; D004867:Equipment Design; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007271:Injections, Intradermal / Q000009:adverse effects; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects* / Q000737:chemistry*; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D011446:Prospective Studies; D012867:Skin / Q000187:drug effects*; D017693:Sodium Bicarbonate / Q000737:chemistry*
D017693:Sodium Bicarbonate; D008012:Lidocaine