One Percent Buffered vs Two Percent Unbuffered Lidocaine Injections in Children

 

TAKE-HOME MESSAGE

  • In this randomized, double-blind, crossover study, 25 children aged 10 to 12 years old participated to evaluate the anesthetic and physiologic differences between buffered 1% lidocaine and unbuffered 2% lidocaine (both with 1:100,000 epinephrine) for inferior alveolar nerve block. No significant differences were found in terms of onset time of soft tissue anesthesia, duration of anesthesia (although a trend was found for longer pulpal anesthesia with the buffered solution), and pain upon injection. The serum concentration of lidocaine was over twice as high in the 2% unbuffered group compared with the 1% buffered group.

  • Both traditional 2% lidocaine and buffered 1% lidocaine injections are safe in children when using the appropriate technique. The primary advantage of a buffered solution was the reduction in lidocaine blood plasma concentration, as no significant differences on pain or anesthesia duration were found.
–  James Boynton, DDS, MS

PURPOSE

Buffered local anesthetics offer an alternative to conventional, unbuffered anesthetic formulations; however, evidence about their use in children is scant. The purpose of this study was to determine the anesthetic and physiologic differences associated with the use of buffered one percent and unbuffered two percent lidocaine (both with 1:100,000 epinephrine) in children.

METHODS

In this randomized, double-blinded, crossover study, 25 children ages 10 to 12 years old received two inferior alveolar never blocks, at least one week apart, randomized to alternating sequences of two drug formulations: (1) formula A-three mL buffered one percent lidocaine (i.e., including 0.3 mL of 8.4 percent sodium bicarbonate); or (2) formula B-three mL unbuffered two percent lidocaine. Primary outcomes were mean blood lidocaine levels (15 minutes post-injection), timing of clinical signs onset, response to pain on injection, and duration of anesthesia. Analyses relied upon analysis of variance for crossover study designs and a P<0.05 statistical significance criterion.

RESULTS

The buffered formulation resulted in significantly lower mean blood lidocaine levels compared to unbuffered-a 63 percent (P<0.05) weight-adjusted relative decrease. The authors found no important differences in pain upon injection, onset, and duration of anesthesia.

CONCLUSION

The buffered local anesthetic formulation showed equal effectiveness with a double-concentration unbuffered formulation while resulting in lower mean blood lidocaine levels-an important gain for the prevention of anesthetic toxicity.

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