JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY | 卷:83 |
Buffered lidocaine 1%/epinephrine 1:100,000 with sodium bicarbonate (sodium hydrogen carbonate) in a 3:1 ratio is less painful than a 9:1 ratio: A double-blind, randomized, placebo-controlled, crossover trial | |
Article | |
Vent, Alexandra1  Surber, Christian1  Johansen, Nicole Tracy Graf2  Figueiredo, Verena3  Schonbachler, Georg4  Imhof, Laurence1  Buset, Caroline1  Hafner, Jurg1  | |
[1] Univ Hosp Zurich, Dept Dermatol, Gloriastr 31, CH-8091 Zurich, Switzerland | |
[2] Graf Biostat, Winterthur, Switzerland | |
[3] Univ Hosp Zurich, Hosp Pharm, Schlieren, Switzerland | |
[4] Univ Zurich, Inst Psychol, Zurich, Switzerland | |
关键词: 3:1; admixture; bicarbonate; burning sensation; controlled; double-blind; epinephrine; lidocaine; local anesthesia; placebo; randomized; ratio; sodium hydrogen carbonate; trial; unbuffered; | |
DOI : 10.1016/j.jaad.2019.09.088 | |
来源: Elsevier | |
【 摘 要 】
Background: Neutralizing (buffering) lidocaine 1%/epinephrine 1:100,000 solution (Lido/Epi) with sodium hydrogen carbonate (NaHCO3) (also called sodium bicarbonate) is widely used to reduce burning sensations during infiltration of Lido/Epi. Optimal mixing ratios have not been systematically investigated. Objectives: To determine whether a Lido/Epi:NaHCO3 mixing ratio of 3:1 (investigational medicinal product 1) causes less pain during infiltration than a mixing ratio of 9:1 (IMP2) or unbuffered Lido/Epi (IMP3). Methods: Double-blind, randomized, placebo-controlled, crossover trial (n= 2 x 24) with 4 investigational medicinal products (IMP1-4). Results: The 3:1 mixing ratio was significantly less painful than the 9:1 ratio (P=.044). Unbuffered Lido/Epi was more painful than the buffered Lido/Epi (P=.001 vs IMP1; P=.033 vs IMP2). IMP4 (NaCl 0.9% [placebo]) was more painful than any of the anesthetic solutions (P=.001 vs IMP1; P=.001 vs IMP2; P=.016 vs IMP3). In all cases, the anesthesia was effective for at least 3 hours. Limitations: Results of this trial cannot be generalized to other local anesthetics such as prilocaine, bupivacaine, or ropivacaine, which precipitate with NaHCO3 admixtures. Conclusions: Lido/Epi-NaHCO3 mixtures effectively reduce burning pain during infiltration. The 3:1 mixing ratio is significantly less painful than the 9:1 ratio. Reported findings are of high practical relevance, given the extensive use of local anesthesia today.
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