Randomized trial of diphenhydramine versus benzyl alcohol with epinephrine as an alternative to lidocaine local anesthesia.
OBJECTIVE
We compared the pain of infiltration and anesthetic effects of.9% benzyl alcohol with epinephrine, 1% diphenhydramine, and.9% buffered lidocaine.


METHODS
A prospective, randomized, double-blind study comparing benzyl alcohol, diphenhydramine, and lidocaine was carried out on adult volunteers. Each subject received all 3 injections in a standardized manner. Pain of infiltration was measured on a 100-mm visual analog pain scale and analyzed with a Kruskal-Wallis test. Duration of anesthesia was assessed at 5-minute intervals for a maximum of 45 minutes and compared with the use of survival analysis techniques by a log-rank test. Return of sensation by 45 minutes was evaluated with an exact chi2 test. All tests were 2-tailed, with significance defined as P <.05.


RESULTS
Thirty subjects were enrolled. The diphenhydramine median pain score was 55 mm, compared with 12.5 mm for lidocaine and 5 mm for benzyl alcohol (P =.001). Pairwise comparisons showed that all possible combinations were statistically significant. The 3 anesthetics were different with respect to duration of anesthesia (P <.001). Pairwise comparisons revealed a longer duration of anesthesia for lidocaine than for diphenhydramine or benzyl alcohol, but no significant difference was found between diphenhydramine and benzyl alcohol. Pain sensation returned within the 45-minute study period in only 3 of 30 lidocaine injections, compared with 11 of 30 benzyl alcohol injections and 19 of 30 diphenhydramine injections (P =.001).


CONCLUSIONS
Benzyl alcohol is a better alternative than diphenhydramine as a local anesthetic for lidocaine-allergic patients.
Bartfield
J M
JM
Department of Emergency Medicine, Albany Medical College, Albany, NY, USA.
Jandreau
S W
SW
Raccio-Robak
N
N
D000328:Adult; D000779:Anesthetics, Local / Q000009:adverse effects*; D019905:Benzyl Alcohol / Q000009:adverse effects*; D004155:Diphenhydramine / Q000009:adverse effects*; D004311:Double-Blind Method; D004338:Drug Combinations; D004342:Drug Hypersensitivity / Q000517:prevention & control; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D008012:Lidocaine / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000139:chemically induced*; D010147:Pain Measurement; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D000779:Anesthetics, Local; D004338:Drug Combinations; D014662:Vasoconstrictor Agents; D004155:Diphenhydramine; D008012:Lidocaine; D019905:Benzyl Alcohol; D004837:Epinephrine