title: Efficacy of a Buffered 4% Lidocaine Formulation for Incision and Drainage: A Prospective, Randomized, Double-blind Study.
abstract: BACKGROUND
  Incision and drainage of symptomatic emergency patients with facial swelling is painful even after local anesthetics are administered. The purpose of this prospective, randomized, double-blind study was to compare the pain of infiltration and the pain of an incision and drainage procedure of a buffered versus a nonbuffered 4% lidocaine formulation in symptomatic emergency patients presenting with a diagnosis of pulpal necrosis, associated periapical area, and an acute clinical swelling.
  
  
  METHODS
  Eighty-eight emergency patients were randomly divided into 2 groups to receive 2 intraoral infiltration injections (mesial and distal to the swelling) of either 4% lidocaine with 1:100,000 epinephrine buffered with 0.18 mL 8.4% sodium bicarbonate using the Onpharma (Los Gatos, CA) buffering system or 4% lidocaine with 1:100,000 epinephrine. Subjects rated the pain of needle insertion, needle placement, and solution deposition for each injection using a 170-mm visual analog scale. An incision and drainage procedure was performed, and subjects rated the pain of incision, drainage, and dissection on a 170-mm visual analog scale.
  
  
  RESULTS
  No significant differences between the buffered and nonbuffered 4% lidocaine formulations were found for needle insertion, placement, and solution deposition of the infiltration injections or for the treatment phases of incision, drainage, and dissection.
  
  
  CONCLUSIONS
  Buffering a 4% lidocaine formulation did not significantly decrease the pain of infiltrations or significantly decrease the pain of the incision and drainage procedure when compared with a nonbuffered 4% lidocaine formulation in symptomatic patients with a diagnosis of pulpal necrosis and associated acute swelling.
authors.affiliation: Private Practice Limited to Endodontics, Norton Shores, Michigan; Division of Endodontics, The Ohio State University, Columbus, Ohio.
authors.forename: Taryn Kratz
authors.initials: TK
authors.lastname: Harreld
authors.affiliation: Division of Endodontics, The Ohio State University, Columbus, Ohio.
authors.forename: Sara
authors.initials: S
authors.lastname: Fowler
authors.affiliation: Division of Endodontics, The Ohio State University, Columbus, Ohio.
authors.forename: Melissa
authors.initials: M
authors.lastname: Drum
authors.affiliation: Division of Endodontics, The Ohio State University, Columbus, Ohio. Electronic address: reader.2@osu.edu.
authors.forename: Al
authors.initials: A
authors.lastname: Reader
authors.affiliation: Division of Endodontics, The Ohio State University, Columbus, Ohio.
authors.forename: John
authors.initials: J
authors.lastname: Nusstein
authors.affiliation: Division ofBiosciences, The Ohio State University, Columbus, Ohio.
authors.forename: Mike
authors.initials: M
authors.lastname: Beck
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D003790:Dental Pulp Necrosis / Q000601:surgery*; D004311:Double-Blind Method; D004322:Drainage; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine
keywords: 4% lidocaine; buffered lidocaine; incision and drainage; lidocaine