Buffered Versus Non-Buffered Lidocaine With Epinephrine for Mandibular Nerve Block: Clinical Outcomes.
OBJECTIVE
Outcomes for peak blood levels were assessed for buffered 2% lidocaine with 1:100,000 epinephrine compared with non-buffered 2% lidocaine with 1:100,000 epinephrine.


METHODS
In this institutional review board-approved prospective, randomized, double-blinded, crossover trial, the clinical impact of buffered 2% lidocaine with 1:100,000 epinephrine (Anutra Medical, Research Triangle Park, Cary, NC) was compared with the non-buffered drug. Venous blood samples for lidocaine were obtained 30 minutes after a mandibular nerve block with 80 mg of the buffered or unbuffered drug. Two weeks later, the same subjects were tested with the alternate drug combinations. Subjects also reported on pain on injection with a 10-point Likert-type scale and time to lower lip numbness. The explanatory variable was the drug formulation. Outcome variables were subjects' peak blood lidocaine levels, subjective responses to pain on injection, and time to lower lip numbness. Serum lidocaine levels were analyzed with liquid chromatography-mass spectrometry. Statistical analyses were performed using Proc TTEST (SAS 9.3; SAS Institute, Cary, NC), with the crossover option for a 2-period crossover design, to analyze the normally distributed outcome for pain. For non-normally distributed outcomes of blood lidocaine levels and time to lower lip numbness, an assessment of treatment difference was performed using Wilcoxon rank-sum tests with Proc NPAR1WAY (SAS 9.3). Statistical significance was set at a P value less than .05 for all outcomes.


RESULTS
Forty-eight percent of subjects were women, half were Caucasian, 22% were African American, and 13% were Asian. Median age was 21 years (interquartile range [IQR], 20-22 yr), and median body weight was 147 lb (IQR, 130-170 lb). Median blood levels (44 blood samples) at 30 minutes were 1.19 μg/L per kilogram of body weight. Mean blood level differences of lidocaine for each patient were significantly lower after nerve block with the buffered drug compared with the non-buffered agent (P < .01). Mean score for pain on injection for nerve block (n = 46 scores) was 3.3 (standard deviation, 0.9). Seventy-eight percent of subjects reported lower or the same pain scores with the buffered drug; 61% of subjects reported a shorter time to lower lip numbness with the buffered drug.


CONCLUSIONS
Buffering 2% lidocaine with epinephrine can produce clinical outcomes favorable for subjects and clinicians without clinically detrimental peak blood lidocaine levels.
Resident, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina, Chapel Hill, NC.
James A
JA
Phero
Former Dental Student, School of Dentistry, University of North Carolina, Chapel Hill, NC.
Blake
B
Nelson
Dental Student, School of Dentistry, University of North Carolina, Chapel Hill, NC.
Bobby
B
Davis
Dental Student, School of Dentistry, University of North Carolina, Chapel Hill, NC.
Natalie
N
Dunlop
Professor, Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC.
Ceib
C
Phillips
Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina, Chapel Hill, NC.
Glenn
G
Reside
Research Associate, UNC/NCSU Joint Department of Biomedical Engineering, School of Dentistry, University of North Carolina, Chapel Hill, NC.
Andrew P
AP
Tikunov
Dalton L. McMichael Distinguished Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina, Chapel Hill, NC. Electronic address: ray_white@dentistry.unc.edu.
Raymond P
RP
White
D000766:Anesthesia, Dental / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000097:blood; D002021:Buffers; D002853:Chromatography, Liquid; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004338:Drug Combinations; D004837:Epinephrine / Q000008:administration & dosage* / Q000097:blood; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008012:Lidocaine / Q000008:administration & dosage* / Q000097:blood; D008297:Male; D008334:Mandible; D013058:Mass Spectrometry; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010865:Pilot Projects; D011446:Prospective Studies; D055815:Young Adult
D000779:Anesthetics, Local; D002021:Buffers; D004338:Drug Combinations; D008012:Lidocaine; D004837:Epinephrine