title: Dilution of a mepivacaine-adrenaline solution in isotonic sodium bicarbonate for reducing subcutaneous infiltration pain in ambulatory phlebectomy procedures: a randomized, double-blind, controlled trial.
abstract: BACKGROUND
  Varicose veins are treated under local infiltration anesthesia. Literature shows that adding sodium bicarbonate reduces the pain associated with local infiltration anesthesia. Nonetheless, sodium bicarbonate is underused.
  
  
  OBJECTIVE
  We sought to assess if the use of a solution of mepivacaine 2% plus adrenaline with sodium bicarbonate 1.4% results in less pain associated with local infiltration anesthesia preceding ambulatory phlebectomies, compared with standard preparation diluted with normal saline.
  
  
  METHODS
  In all, 100 adult patients undergoing scheduled ambulatory phlebectomy were randomized to receive either a solution of mepivacaine chlorhydrate 2% plus adrenaline in sodium bicarbonate 1.4% or a similar solution diluted in normal saline 0.9%.
  
  
  RESULTS
  Median pain scores associated with local infiltration anesthesia reported in the intervention and control groups were 2 (SD=1.6) and 5 (SD=2.0) (P<.0001), respectively. A general linear model with bootstrapped confidence intervals showed that using the alkalinized solution would lead to a reduction in pain rating of about 3 points.
  
  
  CONCLUSIONS
  Patients were not asked to distinguish the pain of the needle stick from the pain of the infiltration. Moreover, a complete clinical study of sensitivity on the infiltrated area was not conducted.
  
  
  CONCLUSIONS
  Data obtained from this study may contribute to improve local infiltration anesthesia in ambulatory phlebectomy and other phlebologic procedures.
authors.affiliation: Department of Geriatrics, University Campus Bio-Medico, Rome, Italy.
authors.forename: Leo
authors.initials: L
authors.lastname: Moro
authors.affiliation: Department of Geriatrics, University Campus Bio-Medico, Rome, Italy. Electronic address: f.serino@unicampus.it.
authors.forename: Francesco-Maria
authors.initials: FM
authors.lastname: Serino
authors.affiliation: Department of Geriatrics, University Campus Bio-Medico, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ricci
authors.affiliation: Department of Geriatrics, University Campus Bio-Medico, Rome, Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Abbruzzese
authors.affiliation: Department of Geriatrics, University Campus Bio-Medico, Rome, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Antonelli-Incalzi
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000772:Anesthesia, Local / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D007552:Isotonic Solutions; D008297:Male; D008619:Mepivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D010146:Pain / Q000139:chemically induced / Q000517:prevention & control*; D010147:Pain Measurement; D017693:Sodium Bicarbonate / Q000008:administration & dosage*; D012965:Sodium Chloride; D014648:Varicose Veins / Q000601:surgery*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D000779:Anesthetics, Local; D007552:Isotonic Solutions; D014662:Vasoconstrictor Agents; D012965:Sodium Chloride; D017693:Sodium Bicarbonate; D008619:Mepivacaine; D004837:Epinephrine
keywords: alkalinized anesthesia; local infiltration anesthesia; phlebectomy; phlebology; reticular veins; varicose veins