• 1

    Achar, S and S Kundu. :Principles of office anesthesia: part I, Infiltrative anesthesia. .Am Fam Physician 66::91. ,2002. .

  • 2

    Younis, I and RP Bhutiani. :Taking the “ouch” out: effect of buffering commercial xylocaine on infiltration and procedure pain: a prospective, randomised, double-blind, controlled trial. .Ann R Coll Surg Engl 86::213. ,2004. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Doolan, KL . :Buffering lidocaine with sodium bicarbonate. .Am J Hosp Pharm 51::2564. ,1994. .

  • 4

    Matsumoto, AH, AC Reifsnyder, GD Hartwell, et al. :Reducing the discomfort of lidocaine administration through pH buffering. .J Vasc Interv Radiol 5::171. ,1994. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    McKay, W, R Morris, and P Mushlin. :Sodium bicarbonate attenuates pain on skin infiltration with lidocaine, with or without epinephrine. .Anesth Analg 66::572. ,1987. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Christoph, RA, L Buchanan, K Begalla, et al. :Pain reduction in local anesthetic administration through pH buffering. .Ann Emerg Med 17::117. ,1988. .

  • 7

    Scarfone, RJ, M Jasani, and EJ Gracely. :Pain of local anesthetics: rate of administration and buffering. .Ann Emerg Med 31::36. ,1998. .

  • 8

    Fein, JA, CR Boardman, S Stevenson, et al. :Saline with benzyl alcohol as intradermal anesthesia for intravenous line placement in children. .Pediatr Emerg Care 14::119. ,1998. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Minogue, SC and DA Sun. :Bacteriostatic saline containing benzyl alcohol decreases the pain associated with the injection of propofol. .Anesth Analg 100::683. ,2005. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Wilson, L and S Martin. :Benzyl alcohol as an alternative local anesthetic. .Ann Emerg Med 33::495. ,1999. .

  • 11

    Alam, M, JS Dover, and KA Arndt. :Pain associated with injection of botulinum A exotoxin reconstituted using isotonic sodium chloride with and without preservative: a double-blind, randomized controlled trial. .Arch Dermatol 138::510. ,2002. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Whitworth, JM, MD Kanaa, IP Corbett, et al. :Influence of injection speed on the effectiveness of incisive/ mental nerve block: a randomized, controlled, double-blind study in adult volunteers. .J Endod 33::1149. ,2007. .

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 13

    Dexter, F and DH Chestnut. :Analysis of statistical tests to compare visual analog scale measurements among groups. .Anesthesiology 82::896. ,1995. .

  • 14

    Kelly, AM . :Does the clinically significant difference in visual analog scale pain scores vary with gender, age, or cause of pain. ?Acad Emerg Med 5::1086. ,1998. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Kelly, AM . :The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. .Emerg Med J 18::205. ,2001. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Todd, KH, KG Funk, JP Funk, et al. :Clinical significance of reported changes in pain severity. .Ann Emerg Med 27::485. ,1996. .

  • 17

    Dawson, B and RG Trapp. :Basic and Clinical Biostatistics, ,4th Ed. ,McGraw-Hill Professional. ,Springfield, IL. ,2004. .

  • 18

    Daoust, R, P Beaulieu, C Manzini, et al. :Estimation of pain intensity in emergency medicine: a validation study. .Pain 1:38::565. ,2008. .

    • Crossref
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 19

    Palmon, SC, AT Lloyd, and JR Kirsch. :The effect of needle gauge and lidocaine pH on pain during intradermal injection. .Anesth Analg 86::379. ,1998. .

  • 20

    Campbell, MJ and D Machin. :Medical Statistics: A Commonsense Approach, ,3rd Ed. , p91. ,John Wiley & Sons. ,Hoboken, NJ. ,1999. .

Reducing the Pain of Local 1% Lidocaine Infiltration with a Preceding Bacteriostatic Saline Injection

A Double-blind Prospective Trial

Stephen L. Barrett Arizona School of Podiatric Medicine, Midwestern University, Glendale, AZ

Search for other papers by Stephen L. Barrett in
Current site
Google Scholar
PubMed
Close
 DPM, MBA
,
Jim Maxka Arizona School of Podiatric Medicine, Midwestern University, Glendale, AZ

Search for other papers by Jim Maxka in
Current site
Google Scholar
PubMed
Close
 PhD, DPM
,
Jamie N. Mieras Arizona School of Podiatric Medicine, Midwestern University, Glendale, AZ

Search for other papers by Jamie N. Mieras in
Current site
Google Scholar
PubMed
Close
 DPM
, and
Kimbal E. Cooper Biomedical Sciences Program, Midwestern University, Glendale, AZ

Search for other papers by Kimbal E. Cooper in
Current site
Google Scholar
PubMed
Close
 PhD

Background:

Lidocaine injection for local anesthesia is a common podiatric medical procedure. We tested the hypothesis that injection of bacteriostatic saline solution containing 0.9% benzyl alcohol before the lidocaine infiltration can reduce the burning caused by lidocaine injection.

Methods:

This double-blind prospective trial involved 45 participants who each received four injections in two areas of the dorsum of the foot and rated the perceived pain on a visual analog scale. The order of the injections was designed to disguise the control and intervention arms of the study.

Results:

The sensation of the lidocaine injection after the injection of saline was reduced significantly (P = .028). The percentage of lidocaine injections with visual analog scale scores of 0 increased by 36% after preinjection with bacteriostatic saline solution containing 0.9% benzyl alcohol.

Conclusions:

The fact that 40% of the intervention visual analog scale pain scores for lidocaine injections were 0 suggests that a near painless lidocaine injection technique is an achievable goal and that the present technique is a simple and inexpensive method of reducing the pain of lidocaine injections. (J Am Podiatr Med Assoc 101(3): 223–230, 2011)

Corresponding author: Stephen L. Barrett, DPM, Arizona School of Podiatric Medicine, Midwestern University, 19555 N 59th Ave, Glendale, AZ 85308. (E-mail: sbarre@midwestern.edu)