title: Buffered lidocaine for incision and drainage: a prospective, randomized double-blind study.
abstract: BACKGROUND
  Buffered local anesthetics have not been studied for incision and drainage procedures in dentistry. The purpose of this prospective, randomized, double-blind study was to compare the pain of infiltration and pain of an incision and drainage procedure by using a buffered versus a nonbuffered 2% lidocaine with 1:100,000 epinephrine solution in symptomatic patients with a diagnosis of pulpal necrosis and associated acute swelling.
  
  
  METHODS
  Eighty-one adult patients were randomly divided into 2 treatment groups who received 2 infiltrations (mesial and distal to the swelling of the same formulation) by using either 2% lidocaine with 1:100,000 epinephrine buffered with 0.18 mL 8.4% sodium bicarbonate or 2% lidocaine with 1:100,000 epinephrine. Patients rated pain of needle insertion, placement, and solution deposition for each infiltration on a 170-mm visual analog scale. An incision and drainage procedure was performed, and the pain of incision, drainage, and dissection was recorded.
  
  
  RESULTS
  No significant differences were found between the 2 anesthetic formulations for pain of solution deposition for either the mesial or distal site infiltrations. Moderate-to-severe pain was experienced in the majority of patients with the incision and drainage procedure. No significant differences were found between the 2 formulations.
  
  
  CONCLUSIONS
  The addition of a sodium bicarbonate buffer to 2% lidocaine with 1:100,000 epinephrine did not result in significantly decreased pain of infiltrations or significantly decreased pain of the incision and drainage procedure when compared with 2% lidocaine with 1:100,000 epinephrine in symptomatic patients with a diagnosis of pulpal necrosis and associated acute swelling.
authors.affiliation: Division of Endodontics, College of Dentistry, The Ohio State University, Columbus, Ohio.
authors.forename: Matthew
authors.initials: M
authors.lastname: Balasco
authors.forename: Melissa
authors.initials: M
authors.lastname: Drum
authors.forename: Al
authors.initials: A
authors.lastname: Reader
authors.forename: John
authors.initials: J
authors.lastname: Nusstein
authors.forename: Mike
authors.initials: M
authors.lastname: Beck
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000737:chemistry; D002021:Buffers; D003790:Dental Pulp Necrosis / Q000601:surgery; D004210:Dissection / Q000379:methods; D004311:Double-Blind Method; D004322:Drainage / Q000379:methods*; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007267:Injections / Q000295:instrumentation; D008012:Lidocaine / Q000008:administration & dosage* / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D009339:Needles; D010146:Pain / Q000517:prevention & control; D010147:Pain Measurement / Q000379:methods; D017060:Patient Satisfaction; D010482:Periapical Abscess / Q000601:surgery; D011446:Prospective Studies; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000737:chemistry; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D002021:Buffers; D014662:Vasoconstrictor Agents; D017693:Sodium Bicarbonate; D008012:Lidocaine; D004837:Epinephrine
keywords: Buffered anesthetics; incision and drainage; pain