Don't miss a digital issue! Renew/subscribe for FREE today.
×
Compendium
May 2016
Volume 37, Issue 5
Peer-Reviewed

Conclusions

This in vitro study is the first to compare the pH buffering of seven commercially available local anesthetic preparations using a simple chairside hand-mixing technique with commercially available 8.4% sodium bicarbonate, versus the commercially available Onpharma mixing device with the Onset Sodium Bicarbonate Injection, 8.4% USP Neutralizing Additive. Both techniques were equally effective in raising the pH levels of all seven of the commercially available local anesthetics tested despite the Onpharma product having only been approved for buffering lidocaine.

While these results may have some significant clinical implications, additional clinical studies are needed to assess the safety and efficacy of 4% local anesthetic solutions. Additionally, the use of stored buffered solutions is not recommended and dentists should use alkalinized local anesthetic as close to mixing time as possible. Over time, the pH levels of the buffered solutions may continue to rise and, in some cases, a precipitate may form. Furthermore, the production of CO2 as a byproduct of the buffering reaction, while beneficial initially, may result in further instability of the mixture over time.

Acknowledgment

The authors would like to thank lab technician Vilma Torres for her help in testing and storing samples.

Disclosures

DENTSPLY Pharmaceutical, York, PA, donated the local anesthetics solutions used in this study. The authors received no financial assistance or remuneration for the completion of this study.

About the Authors

Jason H. Goodchild, DMD
Clinical Education Manager
Focus North America
Clinical Affairs, Dentsply Sirona Inc.
Milford, Delaware

Mark Donaldson, PharmD
Director
Clinical Pharmacy Performance Services
Vizient Inc.
Whitefish, Montana
Clinical Professor
Department of Pharmacy
University of Montana
Missoula, Montana
Clinical Associate Professor
School of Dentistry
Oregon Health & Science University
Portland, Oregon

References

1. Christoph RA, Buchanan J, Begaila K, Schwartz S. Pain reduction in local anesthetic administration through pH buffering. Ann Emerg Med. 1988;17(2):117-120.

2. Becker DE, Reed KL. Local anesthetics: review of pharmacological considerations. Anesth Prog. 2012;59(2):90-101.

3. Whitcomb M, Drum M, Reader A, et al. A prospective, randomized, double-blind study of the anesthetic efficacy of sodium bicarbonate buffered 2% lidocaine with 1:100,000 epinephrine in inferior alveolar nerve blocks. Anesth Prog. 2010;57(2):59-66.

4. Gissen AJ, Covino BG, Gregus J. Differential sensitivity of fast and slow fibers in mammalian nerve. IV. effect of carbonation of local anesthetics. Reg Anesth. 1985;10(2):68-75.

5. Wong K, Stricharzt GR, Raymond SA. On the mechanisms of potentiation of local anesthetics by bicarbonate buffer: drug structure-activity studies on isolated peripheral nerve. Anesth Analg. 1993;76(1):131-143.

6. Malamed SF, Tavana S, Falkel M. Faster onset and more comfortable injection with alkalinized 2% lidocaine with epinephrine 1:100,000. Compend Contin Educ Dent. 2013;34 spec no 1:10-20.

7. Onpharma® Sodium Bicarbonate Inj., 8.4% USP Neutralizing Additive Solution [package insert]. Los Gatos, CA: Onpharma Inc; 2011. http://www.onpharma.com/pdf/Onpharma_Sodium%20Bicarbonate_Additive_Solution_Package_Insert.pdf. Accessed March 31, 2016.

8. Robertson D, Nusstein J, Reader A, et al. The anesthetic efficacy of articaine in buccal infiltration of mandibular posterior teeth. J Am Dent Assoc. 2007;138(8):1104-1112.

9. Malamed SF. Clinical action of specific agents. In: Handbook of Local Anesthesia. 6th ed. St. Louis, MO: Elsevier Mosby; 2014:56.

10. Wahl MJ, Scmitt MM, Overton DA. Injection pain of prilocaine plain, mepivacaine plain, articaine with epinephrine, and lidocaine with epinephrine. Gen Dent. 2006;54(3):168-171.

11. Malamed SF. Buffering local anesthesics in dentistry. The Pulse. 2011;44(1):7-9.

12. Tortamano IP, Siviero M, Lee S, et al. Onset and duration period of pulpal anesthesia or articaine and lidocaine in inferior alveolar nerve block. Braz Dent J. 2013;24(4):371-374.

13. Catchlove RF. The influence of CO2 and pH on local anesthetic action. J Pharmacol Exp Ther. 1972;181(2):298-309.

14. Bartfield JM, Homer PJ, Ford DT, Sternklar P. Buffered lidocaine and a local anesthetic: an investigation of shelf life. Ann Emerg Med. 1992;21(1):16-19.

15. Robinson J, Fernando R, Sun Wai WY, Reynolds F. Chemical stability of bupivacaine, lidocaine and epinephrine in pH-adjusted solutions. Anaesthesia. 2000;55(9):853-858.

© 2024 BroadcastMed LLC | Privacy Policy