Buffered versus non-buffered lidocaine with epinephrine for subcutaneous implantable venous access devices insertion reduces pain: A randomized trial
DOI:
https://doi.org/10.62438/tunismed.v103i6.5309Keywords:
Vascular Access Devices, pain , Anesthesia, neoplasmsAbstract
Introduction: Implantable ports (Port-a-Caths) are a mainstay in the treatment of cancer patients. While these devices improve patient experience, their insertion can be painful.
Aim: To compare the analgesic efficacy of buffered and non-buffered lidocaine with epinephrine in reducing pain during Port-a-Caths insertion in cancer patients.
Methods: This study was a prospective, randomized, double-blind, controlled trial. One hundred twenty cancer patients scheduled for Port-a-Cath placement under local anesthesia were randomized to receive either buffered (pH=7.33) or non-buffered lidocaine with epinephrine (pH=3.50). The primary outcome was pain assessed during five procedural steps using a standardized 100-mm visual analog scale (VAS). Secondary outcomes included sensory block onset time and patient satisfaction.
Results: One hundred twenty patients were enrolled in this study, with sixty patients in each group. Mean pain scores during local anesthesia infiltration were significantly lower in the buffered lidocaine group (15.7 ± 7.6 mm) compared to the control group (46.9 ± 12.3 mm; p < 0.001). Mean VAS satisfaction scores were significantly higher in the buffered lidocaine group (95.75 ± 8 mm) compared to the control group (70.2 ± 20.1 mm; p < 0.001). Sensory block onset time, as determined by pinprick test, was significantly shorter in buffered lidocaine group (3.25 ± 1.3 min) compared to control group (5.5 ± 1.3 min; p < 0.001).
Conclusion: Alkalinizing lidocaine with epinephrine significantly reduced pain during Port-a-Cath placement in cancer patients, improving anesthesia quality and patient satisfaction.
Downloads
References
Lin L, Li W, Chen C, Wei A, Liu Y. Peripherally inserted central catheters versus implantable port catheters for cancer patients: a meta-analysis. Front Oncol. 2023;13:1228092.
Carvalho B, Fuller A, Brummel C, Cohen SE. Local infiltration of epinephrine-containing lidocaine with bicarbonate reduces superficial bleeding and pain during labor epidural catheter insertion: a randomized trial. Int J Obstet Anesth. avr 2007;16(2):116‑21.
Sadananda V, Jubana M K, Hegde MN, Shetty A, Gatti P. Comparison of buffered and non‑buffered lidocaine: pH and pain perception. World Acad Sci J. 2022;4(5):1‑4.
Valiulla MUE, Halli R, Khandelwal S, Mittal A, Singh A, Bhindora K. Efficacy of Sodium Bicarbonate-Buffered Local Anesthetic Solution in Cases Requiring Bilateral Maxillary Premolar Orthodontic Extraction: A Comparative Split-Mouth Study. Cureus. 2023;15(4):e37934.
Vent A, Surber C, Graf Johansen Nt, Figueiredo V, Schönbächler G, Imhof L, et al. 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. J Am Acad Dermatol. 2020;83(1).
Gorrela H, Srujana T, Arthi S. Buffered versus Non-buffered Local Anaesthesia in Minor Oral Surgery - A Comparative Study. Ann Maxillofac Surg. 2024;14(1).
Rabinowitz Y, Williams S, Triana RR, Khan MTF, Hooker KJ, Dubey A, et al. Assessing the Efficacy of Buffered Versus Nonbuffered Lidocaine in Dental Extractions: A Double-Blinded Randomized Controlled Trial. J Oral Maxillofac Surg. 2024;82(6):684‑91.
Rana V, Fernandes J, Gupta S. Local anaesthesia: Buffered or non-buffered? A comparative study. Indian J Clin Anaesth. 2022;9(4):450–454.
Vasović DD, Karamarković M, Stojičić M, Jovanović M, Savić Vujović K, Rašić D, et al. Buffered Versus Nonbuffered Local Anesthetics and Local Pain Scores in Upper Eyelid Blepharoplasty: Randomized Controlled Trial. Ophthal Plast Reconstr Surg. 2023;39(6):602‑5.
Hockett D, Kress L, Mac Donald R, Krenzischek DA, Maheshwari A. Effectiveness of Buffered Lidocaine for Local Anesthesia During Liver Biopsy. Gastroenterol Nurs Off J Soc Gastroenterol Nurses Assoc. 2021;44(3):172‑6.
Phero JA, Reside GJ, Turner BH, Phillips C, White R. A Comparison of Buffered and Non-Buffered 2% Lidocaine With Epinephrine, a Pilot Study. J Oral Maxillofac Surg. 2016;74(9):e41.
Vasan A, Baker JA, Shelby RA, Soo MSC. Impact of Sodium Bicarbonate-Buffered Lidocaine on Patient Pain During Image-Guided Breast Biopsy. J Am Coll Radiol JACR. 2017;14(9):1194‑201.
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(5):339‑43.
Vossinakis IC, Stavroulaki P, Paleochorlidis I, Badras LS. Reducing the pain associated with local anaesthetic infiltration for open carpal tunnel decompression. J Hand Surg Edinb Scotl. 2004;29(4):399‑401.
Koja DB, Bede SY. Evaluation of buffered local anaesthesia in dental extraction: A randomized controlled study. Oral Surg. 2022;15(4):489‑95.
Nguyen U, Habaluyas K, Oliphant T. DS11 Buffering of lidocaine, time for a British Society for Dermatological Surgery position statement? Br J Dermatol. 2024;191(1):i99.
Jain TK, Jha R, Tiwari A, Agrawal N, Mali S, Sinha A, et al. A Comparative Study to Evaluate the Anesthetic Efficacy of Buffered Versus Non-buffered 2% Lidocaine During Inferior Alveolar Nerve Block. Cureus. 2022;14(11):e31855.
Decloux D, Ouanounou A. Local Anaesthesia in Dentistry: A Review. Int Dent J. 2021;71(2):87‑95.
Yiannakopoulos CK. Carpal ligament decompression under local anaesthesia: the effect of lidocaine warming and alkalinisation on infiltration pain. J Hand Surg Edinb Scotl. 2004;29(1):32‑4.
Harreld TK, Fowler S, Drum M, Reader A, Nusstein J, Beck M. Efficacy of a Buffered 4% Lidocaine Formulation for Incision and Drainage: A Prospective, Randomized, Double-blind Study. J Endod. 2015;41(10):1583‑8.
Saatchi M, Khademi A, Baghaei B, Noormohammadi H. Effect of sodium bicarbonate-buffered lidocaine on the success of inferior alveolar nerve block for teeth with symptomatic irreversible pulpitis: a prospective, randomized double-blind study. J Endod. 2015;41(1):33‑5.
Additional Files
Published
Issue
Section
Categories
License
Copyright (c) 2025 La Tunisie Médicale
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
