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.
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.