title: Prospective comparison between buffered 1% lidocaine-epinephrine and skin cooling in reducing the pain of local anesthetic infiltration.
abstract: BACKGROUND
  Pain associated with the infiltration of local anesthesia is attributed to the acidity of the solution. Buffering with sodium bicarbonate has been used widely to reduce this affect. Growing evidence supports skin cooling (cryoanalgesia) as a measure to reduce infiltration pain.
  
  
  OBJECTIVE
  To compare the effect of 1% lidocaine-epinephrine [1:100,000] buffered with sodium bicarbonate with skin cooling for 2 minutes with ice in reducing the pain of infiltration of anesthetic solution.
  
  
  METHODS
  Sixty healthy volunteers were recruited for this prospective study. Each subject received an intradermal injection of buffered solution in one arm and injection of unbuffered solution after ice application in the other arm. Immediately after each injection, subjects rated pain of infiltration on a 100-mm visual analog scale. Pain scores were compared using the paired t-test.
  
  
  RESULTS
  Sixty percent of subjects reported that pain of infiltration was greater after skin cooling than with buffered solution. Mean ± standard deviation pain scores were 24.8 ± 21.7 for skin cooling and 21.1 ± 20.8 for buffered solution; this difference was not statistically significant.
  
  
  CONCLUSIONS
  There is no significant difference between buffered anesthetic solution (buffering) and skin cooling in reducing the pain of infiltration of 1% lidocaine - epinephrine.
authors: Dermatology Department, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. dr_m_alshahwan@yahoo.com
authors: Mohammed A
authors: MA
authors: Al Shahwan
mesh_terms: D000779:Anesthetics, Local / Q000009:adverse effects*; D002021:Buffers; D017679:Cryotherapy; D004338:Drug Combinations; D004837:Epinephrine / Q000009:adverse effects*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007271:Injections, Intradermal; D008012:Lidocaine / Q000009:adverse effects*; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D017693:Sodium Bicarbonate / Q000627:therapeutic use*; D014662:Vasoconstrictor Agents / Q000009:adverse effects
chemical_list: D000779:Anesthetics, Local; D002021:Buffers; D004338:Drug Combinations; D014662:Vasoconstrictor Agents; D017693:Sodium Bicarbonate; D008012:Lidocaine; D004837:Epinephrine