BUFFERED

ANAESTHETIC
S

Dr Shazeena Qaiser
 CONTENTS

 Mechanism Of Action of local  Characteristics of individual studies

anaesthetics  Benefits
 Factors Influencing Pain  Other Considerations
 Science of Buffering  Conclusion
 How The Intervention Works  References
 Formulation
 Study Questionnaire
BACKGROUND
RN RNH ⁺
 o Many factors influence the pain of injection:
1. pH of lidocaine solution
2. Introduction of needle
3. Rate of injection
4. Pressure from fluid distention of tissue

 Weakly basic amide- lidocaine - unstable at pH of 7.9

 Prepared in acidic formulations to increase its stability and shelf life.
 Resultant pH = typically 4.7
 Well below physiological pH, and acidity can cause tissue irritation that may be perceived by patients
as a stinging or burning pain

Scarfone RJ, Jasani M, Gracely EJ. Pain of local anesthetics: Rate of administration and buffering. Ann Emerg Med 1998;31:36-40.
Momsen OH, Roman CM, Mohammed BA, et al. Neutralization of lidocaine-adrenaline. A simple method for less painful application of local anesthesia. Ugeskr Laeger 2000;162:4391-4.
 BUFFERING OF LOCAL
ANAESTHETICS

BUFFERED
LIDOCAINE
+
CO2

NaHCO3 + HCl NaCl + H2CO3

H2CO3 H2O + CO2
 Bromage et al. (1967)
How the intervention works
CO2 :
• Increase in flow of
Production local anaesthetic
Increase in pH of • Reduced onset time
solution of CO2 +
H2O • Spread of analgesia
by 20% to 30% in
epidural anesthesia

CO2 potentiates local anesthesia by :

1. Direct depressant effect on axon.
2. Concentrating the local anesthetic inside nerve trunk (ion trapping).
3. Converting local anesthetic to the active cationic form within nerve axoplasm
CATCHLOVE (1973) (lowering its internal pH)
 FORMULATION

10:1 or 9:1 ratio

more closely matches the
neutral pH (around 7.4) in
human tissues and
10 or 9 parts 1 part sodium decreases injection pain.
of lidocaine- bicarbonate
epinephrine containing
8.4g/l
CLINICAL TIPS

1. Buffer the anaesthetic immediately before use .

2. This is labeled for use only with lidocaine at this time.

3. Once the NaCO3 cartridge has been loaded into the mixing pen the cartridge should be
used within 12 hours. Make it a habit to change buffer and cartridge connector at the
same time.

4. Store at room temperature.

5. Do not autoclave the mixing pen; use a barrier sleeve or disinfectant wipe.
STUDY QUESTIONNAIRE
 BENEFITS
 FASTER ONSET
 GREATER DEPTH
 INCREASED
EFFECTIVENESS
 PATIENT COMPLIANCE
 REDUCED PAIN
OTHER CONSIDERATIONS

• Buffering decreases usual shelf life

• Antibacterial activity of lidocaine not been found to get diminished by
bicarbonate buffer
• Ong et al. : increasing pH in buffered lignocaine is unable to fully explain
the minimization of pain on injection : clinical experiences: procaine,
chloroprocaine (more acidic) less painful on infiltration.
• Suggestion of possible link in relationship between lipid solubility and
painful infiltration
 CONCLUSION

• Buffering local anesthetics has 2.29 times greater

likelihood of achieving successful anesthesia.
• Ensuring profound anesthesia with minimum discomfort
should be the basic focus of any dental professional
 REFERENCES
1. Christoph, R. A., Buchanan, L., Begalla, K., & Schwartz, S. (1988). Pain reduction in local anesthetic administration through pH buffering.
Annals of Emergency Medicine, 17(2), 117–120.
2. Sajad A et al Minimizing the pain in local anesthesia injection – A review Journal of Pakistan Association of Dermatologists. 2016;26
(2):138-3. 138
3. Kattan, Sereen; Karabucak, Bekir; Hersh, Elliot V.; Korostoff, Johnathan M.; and Hunter, Paul, "Do Buffered Local Anesthetics Provide More
Successful Anesthesia Over Non-Buffered Solutions in Patients Requiring Dental Therapy? – A Systematic Review & Meta-Analysis."
(2017). Dental Theses. 19.
4. Momsen, O. H., Roman, C. M., Mohammed, B. A., & Andersen, G. (2000). Buffering of lignocaine-epinephrine - A simple method for less
painful application of local anaesthesia. danish. Ugeskrift for Laeger, 162(33), 4391-4394
5. Burns CA, Ferris G, Feng C et al. Decreasing the pain of local anesthesia: A prospective, double-blind comparison of buffered, premixed 1%
lidocaine with epinephrine versus 1% lidocaine freshly mixed with epinephrine. J Am Acad Dermatol 2006;54:128-31.
6. Scarfone RJ, Jasani M, Gracely EJ. Pain of local anesthetics: Rate of administration and buffering. Ann Emerg Med 1998;31:36-40.
THANK YOU