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Lignocaine with adrenaline and carbonated Lignocaine with adrenaline for removal of mandibular molar teeth: A Comparative Study

September 2021

September 2021

Authors:

Raj Chakraborty

Sanjeev Kumar

SGT University

Rajeev Pandey

Government of Uttar Pradesh

Background: To compare efficacy between lignocaine with adrenaline and carbonated lignocaine with adrenaline on pain, onset of anesthesia, and duration of anesthesia for removal of mandibular molar teeth. Study Design: All patients who underwent uncomplicated removal of mandibular molar teeth were included and a double blind randomized clinical study was conducted. 100 patients were included who had indications for removal of mandibular molar teeth and they were randomly allocated in two groups equally into Group A (non-carbonated lignocaine with adrenaline) and Group B (carbonated lignocaine with adrenaline). Pain during deposition of local anesthetic solution, the onset of anesthesia and duration of anesthesia were compared among the two groups. Results: Pain was measured on a visual analogue scale (VAS). The mean VAS score was significantly low for carbonated lignocaine group (p< 0.00001). The mean time to onset of local anesthesia in Group B was 52.58 compared with 69.44 in Group A. The duration of action of local anesthesia in Group A and Group B had no significant difference and varied randomly. Conclusion: It can be concluded that alkalized lignocaine with adrenaline has a faster onset of anesthesia and less pain during injection but duration of anesthesia had no difference.

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International Journal of Dental Science and Innovative Research (IJDSIR)

IJDSIR : Dental Publication Service

Available Online at: www.ijdsir.com

Volume – 4, Issue – 4, July - 2021, Page No. : 650 - 655

Corresponding Author: Dr Rajarshi Ghosh, ijdsir, Volume – 4 Issue - 4, Page No. 650 - 655

Page 650

ISSN: 2581-5989

PubMed - National Library of Medicine - ID: 101738774

Lignocaine with adrenaline and carbonated Lignocaine with adrenaline for removal of mandibular molar teeth: A

Comparative Study

1Dr. Rajkumar Chakraborty, BDS, Post Graduate Trainee, ITS Dental College

2Dr Rajarshi Ghosh, MDS, Lecturer, ITS Dental College

3Dr. Rajeev Pandey, MDS, Lecturer, ITS Dental College

4Dr. Sanjeev Kumar, MDS, FDSRCPS, Professor& HOD, ITS Dental College

Corresponding Author: Dr Rajarshi Ghosh, MDS, Lecturer, ITS Dental College

Citation of this Article: Dr. Rajkumar Chakraborty, Dr Rajarshi Ghosh , Dr. Rajeev Pandey, Dr. Sanjeev Kumar,

“Lignocaine with adrenaline and carbonated Lignocaine with adrenaline for removal of mandibular molar teeth: A

Comparative Study”, IJDSIR- July - 2021, Vol. – 4, Issue - 4, P. No. 650 – 655.

creative commons attribution noncommercial License. Which allows others to remix, tweak, and build upon the work non

commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Type of Publication: Original Research Article

Conflicts of Interest: Nil

Abstract

Background: To compare efficacy between lignocaine

with adrenaline and carbonated lignocaine with adrenaline

on pain, onset of anesthesia, and duration of anesthesia for

removal of mandibular molar teeth.

Study Design: All patients who underwent uncomplicated

removal of mandibular molar teeth were included and a

double blind randomized clinical study was conducted.

100 patients were included who had indications for

removal of mandibular molar teeth and they were

randomly allocated in two groups equally into Group A

(non-carbonated lignocaine with adrenaline) and Group B

(carbonated lignocaine with adrenaline). Pain during

deposition of local anesthetic solution, the onset of

anesthesia and duration of anesthesia were compared

among the two groups.

Results: Pain was measured on a visual analogue scale

(VAS). The mean VAS score was significantly low for

carbonated lignocaine group (p< 0.00001). The mean time

to onset of local anesthesia in Group B was 52.58

compared with 69.44 in Group A. The duration of action

of local anesthesia in Group A and Group B had no

significant difference and varied randomly.

Conclusion: It can be concluded that alkalized lignocaine

with adrenaline has a faster onset of anesthesia and less

pain during injection but duration of anesthesia had no

difference.

Keywords: Local Anesthesia; alkalized lignocaine;

exodontia

Introduction

The greatest apprehension for a patient during a dental

visit is tooth extraction; to be precise the local anesthetic

injection is what they dread of. It is often the only painful

part of a dental procedure and requires a lot of technical

maneuvers to make it as less painful as possible.1 It has

always been the main focus also for the dentist to make

Dr Rajarshi Ghosh, et al. International Journal of Dental Science and Innovative Research (IJDSIR)

Page651

the dental procedure as comfortable as possible which in

turn is beneficial for the patient as well as the surgeon.

Sometimes the experience of pain on injection is so bad

that patients decline further interventions under local

anesthesia.1 The main cause of this pain is not only

because of the needle penetration but also due to the tissue

irritation that is caused by injecting the local anesthetic

solution with adrenaline whose composition is adjusted to

prolong its shelf life, thus making it more acidic.2

Molecules in the cartridge mostly exist in water soluble

form and are acidic.20 Conversely, for the anesthetic to

penetrate the nerve sheath, it must be in an unionized free

base form; then the H+ ion needs to dissociate from the

ionized molecule. Since the physiological pH is about 7.4,

an increase in H+ in the tissues could cause pain by

activating nociceptors such as the acid-sensing ion

channels.20

To prevent this pain dentists have used various methods

while depositing local anesthetic solution like topical

anesthetics, slow infiltration, transcutaneous electrical

nerve stimulation(TENS), computer-assisted local

anesthesia (such as WAND) and vibration.2 Another

method of reducing the pain of injection is neutralizing the

local anesthetic solution sodium bicarbonate. There is

overwhelming evidence that buffered local anesthetics

cause less pain on injection or no pain at all.3 The reason

behind this is buffering the solution increases the non-

cationic form of the drug which increases the penetration

of solution into the soft tissue nerve sheath thereby

decreasing the pain during injection and produces rapid

onset of action of local anesthetic solution.4,5 Additionally

the pKa value determines the potency of the drug so

addition of an alkalizing agent into the local anesthetic

solution produces a pH closer to the physiological pH.4

We have studied the effect of adding sodium bicarbonate

to the local anesthetic solution on the pain of injection and

also on the time for the onset of anesthesia and compared

it with a control group where only local anesthetic with

adrenaline was given.

Materials & Methods

A double blind randomized study was conducted in the

department of oral and maxillofacial surgery to compare

the efficacy between carbonated and non-carbonated

lignocaine with adrenaline. After obtaining research and

ethical committee approval, all patients who reported to

the department for removal of the mandibular molar tooth

were included in the study. Exclusion criteria included

conditions like pregnancy, lactating females, history of

local anesthetic allergy, medically compromised patients.

Subjects were randomly divided into two groups as Group

A (control group) and Group B (study group) and 50

subjects were included in each group. A clinical

comparative double-blind study was conducted in which

the operator and the patient had no idea regarding which

solution was deposited to whom. The control group was

given lignocaine hydrochloride with 1:80000 adrenaline

solution by injection and the study group was given the

same solution but with sodium bicarbonate. For buffering

the solution 3ml of 7.5% sodium bicarbonate was added to

30 ml of the above solution which yielded 1/10 dilution. If

the time between injection and preparation of the solution

was more than 5 minutes the solution was discarded.6 The

pH of lignocaine hydrochloride with 1:80000 adrenaline

was 4-4.6 and that of the carbonated solution was 7.5-8.

The procedure was explained to the patient and informed

consent was taken prior to starting the procedure. Local

anesthetic allergic testing was carried out by depositing

0.2ml of a freshly prepared solution in the forearm

intradermally using a 2ml disposable syringe. After

administering the test dose, the patient was monitored for

30 minutes for signs and symptoms of an allergic reaction.

All patients were given inferior alveolar, lingual and long

Dr Rajarshi Ghosh, et al. International Journal of Dental Science and Innovative Research (IJDSIR)

Page652

buccal nerve block using 2ml single-use syringes with of

length 25mm with 24 gauge needle. Patients were kept

under observation in the department for first post-

operative hour and were discharged only if there were no

complications.

Pain during injection was assessed using a four-point

scale: 0= no pain, 1= mild pain (pain reported only on

questioning), 2= moderate pain (pain reported

spontaneously without questioning), 3= severe pain

(strong vocal response and grimaces, withdrawal of arms,

tears).1

The time of onset of anesthesia was noted from the first

sensation of numbness or tingling in the anesthetized

region. A straight probe was used to assess the onset by

inserting it in the gingival sulcus of the teeth in the area of

anesthesia. Duration of action of local anesthesia was

calculated from the onset of anesthesia until the need for

postoperative analgesia. This was noted by making hourly

calls to the patient from the first postoperative hour to the

requirement of analgesics.

Data from the VAS were analyzed using the Mann-

Whitney U test and time of onset and duration of action of

anesthesia were analyzed using Student’s t-test.

Probabilities of less than 0.001 were accepted as

statistically significant.

Results

Among patients given lignocaine without sodium

bicarbonate 36 patient’s experienced severe pain, 12

patients had moderate pain and 2 patients experienced

mild pain. On the contrary among all the patients who

were given lignocaine with sodium bicarbonate only 2 of

them experienced severe pain, 18 complained of moderate

pain, 21 had mild pain and 9 patients had no pain at all

(Figure 1). There was a significant difference statistically

between the mean VAS score in Group A and Group B.

The mean (SD) time (seconds) to the onset of anesthesia

was 69.4 (11.5)

(9.7) (Figure 2). No statistical difference was found in this

parameter and results varied randomly in both the groups.

Discussion

Pain is defined as an unpleasant emotional experience

usually initiated by a noxious stimulus and transmitted

over a specialized neural network to the central nervous

system where it is interpreted as such.7 Pain during

injection is mainly due to the pH of local anesthesia

(approx. 6.5) which is further lowered to the range of 3.3

by the addition of adrenaline and sodium bisulfite to the

solution. The pain of injection can be reduced to an extent

by injecting the solution slowly but altering the pH more

towards the alkaline side reduces patient discomfort to a

greater extent. There is a consensus that, for nerves with

intact sheaths, local anesthetics are more potent in

alkaline, than in neutral or acid, conditions.8

Sodium bicarbonate was used as an alkalizing agent in this

study to increase the pH of the local anesthetic to a more

physiological pH. It acts by increasing the plasma

bicarbonate concentration, buffering excess hydrogen ions

and raising the pH of blood, thus reversing clinical signs

of acidosis.9 Alkalizing the anesthetic solution makes the

injection more comfortable, reduces onset time and

increases its effectiveness as sodium bicarbonate increases

the availability of uncharged lidocaine molecules (RN),

also called the free base.9 Additionally, sodium

bicarbonate is also available in the tissues as bicarbonate

ion, which alkalizes the extracellular pH. This increase in

extracellular pH reduces the intracellular pH which also

plays a part in increasing the effect of the local anesthetic

block through protonation of intracellular free base local

anesthetic (“ion trapping”) and increasing the

concentration gradient for the free base local anesthetic

across the plasma membrane.10

Dr Rajarshi Ghosh, et al. International Journal of Dental Science and Innovative Research (IJDSIR)

Page653

Our results of VAS score for pain on injection were quite

similar to studies done by Erramspouse,11 Martin,12

Davies3 and Sarvela et al.13 All of these studies reported

that majority of the patients had no pain on injection when

alkalized local anesthetic solution was used. The free base

form of the local anesthetic solution is more lipids soluble,

and so it diffuses faster into the nerve membrane. The

cytoplasm was acidified by the membrane-permeating

carbon dioxide leading to intracellular trapping of the

cationic form of the local anesthetic agent.14 Increasing

the extracellular pH with constant extracellular

concentration of local anesthetic solution results in a

greater intracellular concentration of local anesthetic and

more complete inhibition of sodium currents whether or

not the intracellular carbon dioxide concentration or pH

changes.10 Sodium bicarbonate ions also non-specifically

reduce the margin of safety for nerve conduction and may

have a direct action on the binding of the local anesthetic

to the sodium channel.15 Gros16 and Ritchie et al17

concluded that the addition of sodium bicarbonate to

solutions of lignocaine reduced the duration of onset of

anesthesia. In our study, the duration of anesthesia varied

between patients randomly. Even though the mean

duration of action was slightly higher in carbonated

lignocaine group but it was not statistically significant.

Similar results were found by Sinnott et al18 and Shyamala

et al6 where they stated that alkalizing lignocaine hastens

the onset of action but does not change the duration of

action.

Conclusion

The physiology, anatomy and the kinetics of the time

course of local anesthetics suggest that the body’s process

of converting the cationic form of local anesthetic to

active RN form are responsible for significant delay,

uncertainty and inconsistency in anesthesia.2 Taking a

patient’s physiology out of the latency equation by

buffering the local anesthetic solution at chairside

immediately prior to injection is an effective method to

increase the efficacy of the anesthetic solution.2

Bicarbonate buffering has been studied and written about

for more than 50 years, and it is a process that has also

been recently published Systemic Review by the Cochrane

Collaboration19, which concluded that sodium bicarbonate

buffering of lidocaine is safe and effective for reducing

injection pain.

We can conclude from this study that buffering a 2%

lidocaine with 1:80000 adrenaline with sodium

bicarbonate significantly decreases the pain on injection,

provide faster onset when compared to non alkalized

lignocaine solution.

References

1. Kashyap VM, Desai R, Reddy PB et al. Effect of

Alkalinisation of lignocaine for intraoral nerve block

on pain during injection, and speed of onset of

anesthesia. Br J Oral Maxillofac Surg 2011; 49(8): 72-

2. Agarwal A, Jithendra KD, Sinha A et al. To evaluate

the anesthetic efficacy of sodium bicarbonate buffered

2% lidocaine with 1:100000 epinephrine in Inferior

Alveolar Nerve Blocks: A prospective, randomized,

double-blind study. Arch of Dent and Med Res 2015;

1(3): 17-23.

3. Davies RJ. Buffering the pain of local anaesthetics: a

systematic review. Emerg Med 2003;15:81–89.

4. Gupta RP, Kapoor G (2006) Safety and efficacy of

sodium bicarbonate versus hyaluronidase in peribulbar

anaesthesia. MJAFI 62:116–118

5. Fulling PD, Peterfreund RA (2000) Alkalinisation and

precipitation characteristics of 0.2 % ropivacaine. Reg

Anesth Pain Med 25(5):518–521

6. Shyamala M, Ramesh C, Yuvraj V. A Comparitive

Study between Bupivacaine with Adrenaline and

Dr Rajarshi Ghosh, et al. International Journal of Dental Science and Innovative Research (IJDSIR)

Page654

Carbonated Bupivacaine with Adrenaline for Surgical

Removal of Impacted Mandibular Third Molar. J

Maxillofac Oral Surg 2016; 15(1): 99-105

7. Bennett CR, editor. Monheim’s local anesthesia and

pain control in dental practise. 7th ed. St. Louis: CV

Mosby; 1984

8. Bokesch PM, Raymond SA, Strichartz GR.

Dependence of lidocaine potency on pH and pCO2.

Anesth Analg 1987; 66:9–17.

9. Dollery C. Therapeutic drugs, vol. 2, 2nd ed.

Edinburgh: Churchill Livingstone; 1999.

10. Arndt KA, Burton C, Noe JM. Minimizing the pain of

local anesthesia. Plast Reconstr Surg 1983;72: 676–

679.

11. Erramouspe J. Buffering local anaesthetic solutions

with sodium bicarbonate: literature review and

commentary. Hosp Pharm 1996;31:1275–1282

12. Martin AJ. pH-adjustment and discomfort caused by

the intradermal injection of lignocaine. Anaesthesia

1990;45: 975–978 [Erratum: Anaesthesia

1991;46:242].

13. . Sarvela PJ, Paloheimo PJ, Nikki PH. Comparison of

pH-adjusted bupivacaine 0.75% and a mixture of

bupivacaine 0.75% and lidocaine 2%, both with

hyaluronidase in day-case cataract surgery under

regional anesthesia. Anesth Analg 1994;79: 35–39.

14. Masters JE. Randomized control trial of pH buffered

lignocaine with adrenaline in outpatient operations. Br

J Plast Surg 1998;51: 385–387.

15. Wong K, Strichartz GR, Raymond SA. On the

mechanisms of potentiation of local anesthetics by

bicarbonate buffer: drug structure-activity studies on

isolated peripheral nerve. Anesth Analg 1993;76:

131–143.

16. Gros O. Uber die narkotica und Lokalanasthetica.

Archiv fur experimentelle Pathologie und

Pharmakologie 1910;63: 80–106.

17. Ritchie JM, Ritchie B, Greengard P. The effect of the

nerve sheath on the action of local anesthetics. J

Pharmacol Exp Ther 1965;150: 160–164.

18. Sinnott CJ, Garfield JM, Thalhammer JG, Strichartz

GR. Addition of sodium bicarbonate to lidocaine

decreases the duration of peripheral nerve block in the

rat. Anesthesiology. 2000; 93(4): 1045-1052

19. Cepeda MS, Tzortzopoulou A, Thackrey M, et al.

Adjusting the pH of lidocaine for reducing pain on

injection. Cochrane Database Syst Rev 2010;CD: 65-

81.

20. Aulestia-Viera PV, Braga MM, Borsatti MA. The

effect of adjusting the pH of local anesthetics in

dentistry: a systematic review and meta-analysis. Int

Endod J 2018;51(8):862-876

Legend Figures

Figure1: VAS score comparison among patients of control

and study group

Dr Rajarshi Ghosh, et al. International Journal of Dental Science and Innovative Research (IJDSIR)

Page655

Figure 2: Mean comparison of time of onset of anesthesia

and duration of anesthesia among control and study group

ResearchGate has not been able to resolve any citations for this publication.

Safety and Efficacy of Sodium Bicarbonate versus Hyaluronidase in Peribulbar Anaesthesia

Article

Full-text available

Apr 2006

Background: 400 cases undergoing surgery for cataract under local anaesthesia were studied. Peribulbar anaesthesia involves injecting a mixture of 2% lignocaine, bupivicaine 0.5% and hyaluronidase into the peripheral space of the orbit through a single infero-lateral point. Sodium bicarbonate has been shown to reduce the time of onset of anaesthesia and pain perception when mixed with local anaesthetics. Methods: This study compared two groups of patients (200 each), one receiving hyaluronidase mixed anaesthetic and the other sodium bicarbonate buffered anaesthetic. The groups were compared for effectiveness of the anaesthesia, its onset, duration and the final visual outcome. Results and conclusion: Sodium bicarbonate was shown to reduce the time of onset and increase the successful block rate without any adverse affects.

The effect of adjusting the pH of local anaesthetics in dentistry: A systematic review and meta-analysis

Article

Jan 2018

The acidic nature of commercial local anaesthetics (LAs) can cause pain during infiltration and delay the onset of anaesthesia. It is suggested that adjusting the pH of anaesthetic agents could minimize these effects. This systematic review aimed to evaluate the efficacy of buffered LAs in reducing infiltration pain and onset time in during dental procedures. MEDLINE, Embase, Scopus, and Scielo databases were searched up to April 2017. Randomized controlled trials comparing buffered and unbuffered LAs for intraoral injections were included. Risk of bias was assessed using the Cochrane Collaboration tool. Data upon injection pain and onset time were pooled in a random-effects model. Subgroup analyses compared normal and inflamed tissues, and terminal infiltrations and inferior alveolar nerve (IAN) blocks. Meta-regressions were performed to explain heterogeneity. Fourteen articles were included in this review. Lidocaine with epinephrine was the most used anaesthetic combination. Non-lidocaine studies (n= 2) were not pooled in the meta-analysis. Buffered lidocaine did not result in less pain during intraoral injections: mean difference –6.4 (95% CI –12.81 to 0.01) units in a 0–100 scale. Alkalinized lidocaine did not reduce the onset time in normal tissues when terminal infiltration techniques were used, but resulted in a more rapid onset for IAN blocks (–1.26 minutes) and in inflamed tissues (–1.37 minutes); however, this change may not be clinically relevant, considering the time required to prepare the buffered agent. Studies performed using other anaesthetic salts did not show robust and clinically significant results in favour of alkalinization.

Minimizing the Pain of Local Anesthesia

Article

Sep 1984

Randomised control trial of pH buffered lignocaine with adrenaline in outpatient operations

Article

Jul 1998

JE Masters

Bicarbonate buffering of local anaesthetics is known to significantly decrease the pain of their administration and yet few practising surgeons do so. A double-blind randomised cross-over clinical trial was conducted to confirm the practicality and efficacy of bicarbonate buffering of lignocaine with adrenaline in the setting of a busy local anaesthetic operating theatre. 40 patients received either buffered or control local anaesthetic solutions in equivalent sites on opposite sides of the body. The pain of each injection was rated from 0 (no pain) to 10 (extreme pain). The mean pain score for the buffered solution was significantly lower than the control solution (3.06 vs 4.34, P=0.002). Bicarbonate buffering of lignocaine with adrenaline is effective, inexpensive and simple; its widespread use should be encouraged.

Buffering local anesthetic solutions with sodium bicarbonate: Literature review and commentary

Article

Oct 1996

J. Erramouspe

The objectives of this paper are to review the therapeutic benefits, compatibility, and stability of buffering local anesthetics with sodium bicarbonate. Studies were identified from a MEDLINE search (1966 through April 1996) and by contacting Astra (the manufacturer of Xylocaine). Buffered bupivacaine, lidocaine, and mepivacaine have been shown in clinical trials to decrease injection pain. Bupivacaine, chloroprocaine, etidocaine, lidocaine, and mepivacaine are compatible with sodium bicarbonate buffering under specific conditions of mixing if used within 1 hour. Prilocaine is also compatible with sodium bicarbonate buffering according to one investigator. Stability studies of buffered local anesthetics are few and predominantly involve lidocaine (one study involved bupivacaine). Batch-buffered lidocaine (with and without epinephrine) solutions have been shown to be stable under various storage conditions for 1 to 2 weeks. However, until additional stability data is available, buffering local anesthetics just prior to administration should be preferred to batch preparation.

WITHDRAWN: Adjusting the pH of lidocaine for reducing pain on injection

Article

May 2015

Lidocaine administration produces pain due to its acidic pH. The objective of this review was to determine if adjusting the pH of lidocaine had any effect on pain resulting from non-intravascular injections in adults and children. We tested the hypothesis that adjusting the pH of lidocaine solution to a level closer to the physiologic pH reduces this pain. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, to June 2010); Ovid MEDLINE (1966 to June 2010); EMBASE (1988 to June 2010); LILACS (1982 to June 2010); CINAHL (1982 to June 2010); ISI Web of Science (1999 to June 2010); and abstracts of the meetings of the American Society of Anesthesiologists (ASA). We checked the full articles of selected titles. We did not apply any language restrictions. We included double-blinded, randomized controlled trials that compared pH-adjusted lidocaine with unadjusted lidocaine. We evaluated pain at the injection site, satisfaction and adverse events. We excluded studies in healthy volunteers. We separately analysed parallel-group and crossover trials; trials that evaluated lidocaine with or without epinephrine; and trials with pH-adjusted lidocaine solutions < 7.35 and ≥ 7.35. To explain heterogeneity, we separately analysed studies with a low and higher risk of bias due to the level of allocation concealment; studies that employed a low and a higher volume of injection; and studies that used lidocaine for different types of procedures. We included 23 studies of which 10 had a parallel design and 13 were crossover studies. Eight of the 23 studies had moderate to high risk of bias due to the level of allocation concealment.Pain associated with the infiltration of buffered lidocaine was less than the pain associated with infiltration of unbuffered lidocaine in both parallel and crossover trials. In the crossover studies, the difference was -1.98 units (95% confidence interval (CI) -2.62 to -1.34) and in the parallel-group studies it was -0.98 units (95% CI -1.49 to -0.47) on a 0 to 10 scale. The magnitude of the pain decrease associated with buffered lidocaine was larger when the solution contained epinephrine. The risk of bias, volume of injection, and type of procedure failed to explain the heterogeneity of the results.Patients preferred buffered lidocaine (odds ratio 3.01, 95% CI 2.19 to 4.15). No adverse events or toxicity were reported. Increasing the pH of lidocaine decreased pain on injection and augmented patient comfort and satisfaction.

Effect of alkalinisation of lignocaine for intraoral nerve block on pain during injection, and speed of onset of anaesthesia

Article

May 2011

Injections of lignocaine as local anaesthetic for pain control in oral and maxillofacial surgery can themselves be painful. The time of onset of anaesthesia is from 3 to 5 min. Sodium bicarbonate has been used worldwide to reduce both these drawbacks to the injection, so making procedures more acceptable. This randomised prospective trial of 100 patients aged 18-55 years who were given 3 nerve blocks (inferior alveolar, lingual, and long buccal) was designed to assess the effect of alkalinisation of the lignocaine solution with sodium bicarbonate. All patients were given 2% lignocaine hydrochloride with adrenaline 1:80,000 and 50 patients were randomly allocated to be given 8.4% sodium bicarbonate in a 1/10 dilution. Pain was measured on a visual analogue scale (VAS). No patient given the injection with sodium bicarbonate complained of pain, compared with 39/50 (78%) not given sodium bicarbonate (p<0.0001). The mean (SD) time (seconds) to onset of local anaesthesia in the group given sodium bicarbonate was 34.4 (9.8) compared with 109.8 (31.6) in the control group (p<0.001). Our results have confirmed the efficacy of the alkalinised local anaesthetic solution in reducing pain on injection and resulting in quicker onset of anaesthesia.

pH-adjustment and discomfort caused by the intradermal injection of lignocaine

Article

Dec 1990

A J Martin

One hundred adult day-case patients who required intravenous access had cannulae inserted using local anaesthesia with 1% lignocaine, 1% lignocaine with adrenaline or the corresponding pH-adjusted solutions. The local anaesthetic solutions were modified by the addition of 1 ml 8.4% sodium bicarbonate to 10 ml lignocaine. Pain scores at different stages of cannulation were noted and showed a significant reduction after use of pH-adjusted solutions (p less than 0.02 for the plain lignocaine, and less than 0.001 for the lignocaine with adrenaline). Modification of the pH of lignocaine solutions by the addition of sodium bicarbonate is a simple method significantly to reduce the discomfort caused by the infiltration of the local anaesthetic.

Dependence of Lidocaine Potency on pH and PCO2

Article

Feb 1987
ANESTH ANALG

Lidocaine solutions with different concentrations of CO2, NaOH, and HCl in two buffering systems were applied to frog sciatic nerves. The peak of the compound action potential (APc) and the firing threshold for single axons were measured. The amount of lidocaine required at steady state to double the firing threshold of single fibers or to reduce the peak of the APc by 40% was used as the index of potency. Acidification with CO2 increased potency (less lidocaine was needed to achieve either criterion), whereas acidification with HCl diminished potency, as compared with alkaline conditions. These results were true whether or not the perineurium was present. Frequency-dependent block (Bf) increased in acid conditions produced by CO2, whereas Bf was less under acid conditions produced with HCl (P less than 0.02). The experiments indicate that CO2 potentiates conduction block with lidocaine either by a direct effect on the membrane or by its indirect action on intracellular pH, but not from effects on the extracellular pH.

The effect of the nerve sheath on the action of local anesthetics

Article

Nov 1965

Lignocaine with adrenaline and carbonated Lignocaine with adrenaline for removal of mandibular molar teeth: A Comparative Study

Abstract

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