How acidic is the lidocaine we are injecting, and how much bicarbonate should we add?

Canadian Journal of Plastic Surgery

Volumn 20, Issue 2, 2012, Pages 71-73

  Frank, Simon G ^a   Lalonde, Donald H ^a  

^a DALHOUSIE UNIVERSITY   (Canada)

Author keywords

Anesthetics; Epinephrine; Lidocaine; Local; Pain of injection; PH

Indexed keywords

EID: 84861844486     PISSN: 11952199     EISSN: None     Source Type: Journal    
DOI: 10.1177/229255031202000207     Document Type: Article

References (21)

1. Vossinakis IC. Re: Reduction in pain associated with open carpal tunnel decompression. J Hand Surg Br 2001;26:503-4. (Pubitemid 32982291)
2. Cepeda MS, Tzortzopoulou A, Thackrey M, Hudcova J, Arora Gandhi P, Schumann R. Adjusting the pH of lidocaine for reducing pain on injection. Cochrane Database Syst Rev 2010;(12):CD006581.
3. Gerweck LE, Seetharaman K. Cellular pH gradient in tumor versus normal tissue: Potential exploitation for the treatment of cancer. Cancer Res. 1996;56:1194-8. (Pubitemid 26080953)
4. Momsen OH, Roman CM, Mohammed BA, Andersen G. Neutralization of lidocaine-adrenaline. A simple method for less painful application of local anesthesia. Ugeskr Laeger 2000;162:4391-4. (Pubitemid 30646405)
5. Lalonde DH. "Hole-in-one" local anesthesia for wide-awake carpal tunnel surgery. Plast Reconstr Surg 2010;126:1642-4.
6. Gershon RY, Mokriski BK, Matjasko MJ. Intradermal anesthesia and comparison of intravenous catheter gauge. Anesth Analg 1991;73:469-70.
7. Sapin P, Petrozzi R, Dehmer GJ. Reduction in injection pain using buffered lidocaine as a local anesthetic before cardiac catheterization. Cathet Cardiovasc Diagn 1991;23:100-2.
8. Thomson CJ, Lalonde DH, Denkler KA, Feicht AJ. A critical look at the evidence for and against elective epinephrine use in the finger. Plast Reconstr Surg 2007;119:260-6. (Pubitemid 46360273)
9. Fitzcharles-Bowe C, Denkler K, Lalonde D. Finger injection with high-dose (1:1,000) epinephrine: Does it cause finger necrosis and should it be treated? Hand (N Y) 2007;2:5-11.
10. Lalonde D, Bell M, Benoit P, Sparkes G, Denkler K, Chang P. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: The Dalhousie project clinical phase. J Hand Surg Am 2005;30:1061-7. (Pubitemid 41337938)
11. Nodwell T LD. How long does it take phentolamine to reverse adrenaline-induced vasoconstriction in the finger and hand? A prospective randomized blinded study: The Dalhousie project experimental phase. Can J Plast Surg 2003;11:187.
12. Thomson CJ, Lalonde DH. Randomized double-blind comparison of duration of anesthesia among three commonly used agents in digital nerve block. Plast Reconstr Surg 2006;118:429-32. (Pubitemid 44162051)
13. Parham SM, Pasieka JL. Effect of pH modification by bicarbonate on pain after subcutaneous lidocaine injection. Can J Surg 1996;39:31-5. (Pubitemid 26076816)
14. Watts AC, Gaston P, Hooper G. Randomized trial of buffered versus plain lidocaine for local anaesthesia in open carpal tunnel decompression. J Hand Surg Br 2004;29:30-1. (Pubitemid 38180642)
15. Bartfield JM, Crisafulli KM, Raccio-Robak N, Salluzzo RF. The effects of warming and buffering on pain of infiltration of lidocaine. Acad Emerg Med. 1995;2:254-8.
16. Palmon SC, Lloyd AT, Kirsch JR. The effect of needle gauge and lidocaine pH on pain during intradermal injection. Anesth Analg 1998;86:379-81. (Pubitemid 28079495)
17. Xia Y, Chen E, Tibbits DL, Reilley TE, McSweeney TD. Comparison of effects of lidocaine hydrochloride, buffered lidocaine, diphenhydramine, and normal saline after intradermal injection. J Clin Anesth 2002;14:339-43.
18. Serour F, Levine A, Mandelberg A, Ben Yehuda Y, Boaz M, Mori J. Alkalinizing local anesthetic does not decrease pain during injection for dorsal penile nerve block. J Clin Anesth 1999;11:563-6.
19. Ririe DG, Walker FO, James RL, Butterworth J. Effect of alkalinization of lidocaine on median nerve block. Br J Anaesth 2000;84:163-8. (Pubitemid 30060298)
20. Morris R, McKay W, Mushlin P. Comparison of pain associated with intradermal and subcutaneous infiltration with various local anesthetic solutions. Anesth Analg 1987;66:1180-2. (Pubitemid 18028677)
21. Dejong RH, Cullen SC. Buffer-demand and ph of local anesthetic solutions containing epinephrine. Anesthesiology 1963;24:801-7.