Increasing the pH of lidocaine solution decreases pain on injection and improves patient comfort and satisfaction

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This is a critical appraisal of a Cochrane review first published in December 2010.  The appraisal was prepared under the auspices of the American Dental Associations Centre for Evidence-based Dentistry

The objective of the Cochrane review was to determine if adjusting the pH of lidocaine had any effect on pain resulting from non-intravascular injections in adults and children.

The reviewer found this to be a well conducted review  but noted that the effect of alkalization on lidocaine on the quality of the sensory nerve block was not evaluated.

Overall the evidence suggests that increasing the pH of lidocaine solution with sodium bicarbonate decreases pain on injection and augments patient comfort and satisfaction.

In the section on implications for dental practice the reviewer noted the need for oral trials and further work because of the impact of buffering on the stability of anaesthetics.

Go to the ADA Summary

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 of Systematic Reviews 2010, Issue 12. Art. No.: CD006581. DOI: 10.1002/14651858.CD006581.pub2.



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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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