The effect of buffering on pain and duration of local anesthetic in the face: A double-blind, randomized controlled trial.
BACKGROUND
The acidity of lidocaine preparations is believed to contribute to the pain of local anesthetic injection.


OBJECTIVE
To investigate the effect of buffering lidocaine on the pain of injection and duration of anesthetic effect.


METHODS
A double-blind, randomized trial involving 44 healthy volunteers was conducted. The upper lip was injected with a solution of: lidocaine 1% (Xylocaine, AstraZeneca, Canada, Inc) with epinephrine; and lidocaine 1% with epinephrine and 8.4% sodium bicarbonate. Volunteers reported pain of injection and duration of anesthetic effect.


RESULTS
Twenty-six participants found the unbuffered solution to be more painful. Fifteen participants found the buffered solution to be more painful; the difference was not statistically significant. Twenty-one volunteers reported duration of anesthetic effect. The buffered solution provided longer anesthetic effect than the unbuffered solution (P=0.004).


CONCLUSIONS
Although buffering increased the duration of lidocaine's anesthetic effect in this particular model, a decrease in the pain of the injection was not demonstrated, likely due to limitations of the study.
Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia.
Oluwatola
O
Afolabi
Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia.
Amanda
A
Murphy
Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia.
Bryan
B
Chung
Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia.
Donald H
DH
Lalonde
Lidocaine; Local anesthesia; Pain; Sodium bicarbonate