Alkalinizing local anesthetic does not decrease pain during injection for dorsal penile nerve block.
OBJECTIVE
To evaluate whether alkalizing local anesthetic with sodium bicarbonate reduces pain related to infiltration of local anesthetic during dorsal penile nerve block for circumcision.


METHODS
Prospective, randomized, double-blind, controlled study.


METHODS
E. Wolfson Medical Center, Holon, Israel.


METHODS
144 patients aged 15 to 54 years (mean +/- SD = 22.7 +/- 8.8 years), randomized before the block into four groups of 36 patients each.


METHODS
Group A (control) received a standard solution of 1 mg/kg lidocaine 2% mixed with 0.5 mg/kg bupivacaine 0.5% without epinephrine (pH = 6.3). Patients in Group B, Group C, and Group D received this mixture added with 8.4% sodium bicarbonate for a mean final pH of 6.90, 7.16, and 7.43, respectively. Penile block was performed using a 23-gauge needle by an anesthetist who was blinded to the pH of the solution.


RESULTS
Patients were questioned regarding pain suffered during injection of the anesthetic solutions by another physicians who also was blinded to the drug used. Pain was rated by a previously reported subjective pain scale. Mean pain scales were 2.0 +/- 0.17, 2.3 +/- 0.15, 2.2 +/- 0.16, and 1.94 +/- 0.15 for Groups A to D, respectively. The differences between these results were not statistically significant.


CONCLUSIONS
Alkalinizing the acidic local anesthetic solution by sodium bicarbonate does not decrease pain related to infiltration during penile nerve block for circumcision.
Serour
F
F
Department of Pediatrics, Edith Wolfson Medical Center, Holon, Israel. fhserour@yahoo.com
Levine
A
A
Mandelberg
A
A
Ben Yehuda
Y
Y
Boaz
M
M
Mori
J
J
D000293:Adolescent; D000328:Adult; D000468:Alkalies / Q000737:chemistry*; D000704:Analysis of Variance; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000737:chemistry*; D002021:Buffers; D002045:Bupivacaine / Q000008:administration & dosage; D002944:Circumcision, Male; D004311:Double-Blind Method; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007279:Injections, Subcutaneous / Q000009:adverse effects / Q000295:instrumentation; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009339:Needles / Q000009:adverse effects; D009407:Nerve Block / Q000009:adverse effects* / Q000295:instrumentation; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D010413:Penis / Q000294:innervation; D011446:Prospective Studies; D017693:Sodium Bicarbonate / Q000737:chemistry*
D000468:Alkalies; D000779:Anesthetics, Local; D002021:Buffers; D017693:Sodium Bicarbonate; D008012:Lidocaine; D002045:Bupivacaine