title: A randomized trial of buffered versus nonbuffered lidocaine with epinephrine for cervical loop excision.
abstract: OBJECTIVE
  Our study evaluated whether buffering reduces pain from lidocaine injection for loop electrosurgical excisional procedures (LEEPs) of the cervix when compared to unbuffered lidocaine.
  
  
  METHODS
  Women undergoing outpatient LEEPs were randomized to receive either buffered or unbuffered lidocaine. Participants, caregivers, and statisticians were blinded to treatment allocation. Pain was categorized as injection, procedure, or cramping pain. Severity of pain was reported using a Likert visual analog scale and compared using Mann-Whitney tests.
  
  
  RESULTS
  Twenty-eight subjects received buffered lidocaine and 24 subjects received unbuffered lidocaine. The 2 groups were similar in regard to age, race, previous LEEP, anesthetic volume used, and loop size. Mean scores were similar between the nonbuffered and buffered groups for injection pain (25 vs 19, p = .13), procedure pain (27 vs 19, p = .08), and cramping pain (19 vs 18, p = .86).
  
  
  CONCLUSIONS
  Pain scores with subepithelial lidocaine plus epinephrine for LEEP are low and are not significantly reduced by buffering the anesthetic.
authors.affiliation: Divisions of 1Gynecologic Oncology and 2Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, Saint Louis, MO.
authors.forename: Nora T
authors.initials: NT
authors.lastname: Kizer
authors.forename: Qiuhong
authors.initials: Q
authors.lastname: Zhao
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Peipert
authors.forename: Yevgeniya
authors.initials: Y
authors.lastname: Ioffe
authors.forename: L Stewart
authors.initials: LS
authors.lastname: Massad
mesh_terms: D000293:Adolescent; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002021:Buffers; D004311:Double-Blind Method; D004598:Electrosurgery / Q000379:methods*; D004837:Epinephrine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D010146:Pain / Q000139:chemically induced* / Q000517:prevention & control; D002583:Uterine Cervical Neoplasms / Q000601:surgery*; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D002021:Buffers; D008012:Lidocaine; D004837:Epinephrine