Buffered Versus Non-Buffered Lidocaine With Epinephrine for Mandibular Nerve Block: Clinical Outcomes

James A. Phero, Blake Nelson, Bobby Davis, Natalie Dunlop, Ceib Phillips, Glenn Reside, Andrew P. Tikunov, Raymond P. White

Research output: Contribution to journalArticle

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Abstract

Purpose Outcomes for peak blood levels were assessed for buffered 2% lidocaine with 1:100,000 epinephrine compared with non-buffered 2% lidocaine with 1:100,000 epinephrine. Patients and Methods In this institutional review board–approved prospective, randomized, double-blinded, crossover trial, the clinical impact of buffered 2% lidocaine with 1:100,000 epinephrine (Anutra Medical, Research Triangle Park, Cary, NC) was compared with the non-buffered drug. Venous blood samples for lidocaine were obtained 30 minutes after a mandibular nerve block with 80 mg of the buffered or unbuffered drug. Two weeks later, the same subjects were tested with the alternate drug combinations. Subjects also reported on pain on injection with a 10-point Likert-type scale and time to lower lip numbness. The explanatory variable was the drug formulation. Outcome variables were subjects' peak blood lidocaine levels, subjective responses to pain on injection, and time to lower lip numbness. Serum lidocaine levels were analyzed with liquid chromatography-mass spectrometry. Statistical analyses were performed using Proc TTEST (SAS 9.3; SAS Institute, Cary, NC), with the crossover option for a 2-period crossover design, to analyze the normally distributed outcome for pain. For non-normally distributed outcomes of blood lidocaine levels and time to lower lip numbness, an assessment of treatment difference was performed using Wilcoxon rank-sum tests with Proc NPAR1WAY (SAS 9.3). Statistical significance was set at a P value less than .05 for all outcomes. Results Forty-eight percent of subjects were women, half were Caucasian, 22% were African American, and 13% were Asian. Median age was 21 years (interquartile range [IQR], 20-22 yr), and median body weight was 147 lb (IQR, 130-170 lb). Median blood levels (44 blood samples) at 30 minutes were 1.19 μg/L per kilogram of body weight. Mean blood level differences of lidocaine for each patient were significantly lower after nerve block with the buffered drug compared with the non-buffered agent (P < .01). Mean score for pain on injection for nerve block (n = 46 scores) was 3.3 (standard deviation, 0.9). Seventy-eight percent of subjects reported lower or the same pain scores with the buffered drug; 61% of subjects reported a shorter time to lower lip numbness with the buffered drug. Conclusions Buffering 2% lidocaine with epinephrine can produce clinical outcomes favorable for subjects and clinicians without clinically detrimental peak blood lidocaine levels.

LanguageEnglish (US)
Pages688-693
Number of pages6
JournalJournal of Oral and Maxillofacial Surgery
Volume75
Issue number4
DOIs
StatePublished - Apr 1 2017

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Mandibular Nerve
Nerve Block
Lidocaine
Epinephrine
Hypesthesia
Lip
Pain
Pharmaceutical Preparations
Nonparametric Statistics
Cross-Over Studies
Injections
Body Weight
Drug Compounding
Research Ethics Committees
Drug Combinations
Liquid Chromatography
African Americans
Biomedical Research
Mass Spectrometry

ASJC Scopus subject areas

  • Surgery
  • Oral Surgery
  • Otorhinolaryngology

Cite this

Buffered Versus Non-Buffered Lidocaine With Epinephrine for Mandibular Nerve Block : Clinical Outcomes. / Phero, James A.; Nelson, Blake; Davis, Bobby; Dunlop, Natalie; Phillips, Ceib; Reside, Glenn; Tikunov, Andrew P.; White, Raymond P.

In: Journal of Oral and Maxillofacial Surgery, Vol. 75, No. 4, 01.04.2017, p. 688-693.

Research output: Contribution to journalArticle

Phero, James A. ; Nelson, Blake ; Davis, Bobby ; Dunlop, Natalie ; Phillips, Ceib ; Reside, Glenn ; Tikunov, Andrew P. ; White, Raymond P. / Buffered Versus Non-Buffered Lidocaine With Epinephrine for Mandibular Nerve Block : Clinical Outcomes. In: Journal of Oral and Maxillofacial Surgery. 2017 ; Vol. 75, No. 4. pp. 688-693.
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AU - Davis, Bobby

AU - Dunlop, Natalie

AU - Phillips, Ceib

AU - Reside, Glenn

AU - Tikunov, Andrew P.

AU - White, Raymond P.

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N2 - Purpose Outcomes for peak blood levels were assessed for buffered 2% lidocaine with 1:100,000 epinephrine compared with non-buffered 2% lidocaine with 1:100,000 epinephrine. Patients and Methods In this institutional review board–approved prospective, randomized, double-blinded, crossover trial, the clinical impact of buffered 2% lidocaine with 1:100,000 epinephrine (Anutra Medical, Research Triangle Park, Cary, NC) was compared with the non-buffered drug. Venous blood samples for lidocaine were obtained 30 minutes after a mandibular nerve block with 80 mg of the buffered or unbuffered drug. Two weeks later, the same subjects were tested with the alternate drug combinations. Subjects also reported on pain on injection with a 10-point Likert-type scale and time to lower lip numbness. The explanatory variable was the drug formulation. Outcome variables were subjects' peak blood lidocaine levels, subjective responses to pain on injection, and time to lower lip numbness. Serum lidocaine levels were analyzed with liquid chromatography-mass spectrometry. Statistical analyses were performed using Proc TTEST (SAS 9.3; SAS Institute, Cary, NC), with the crossover option for a 2-period crossover design, to analyze the normally distributed outcome for pain. For non-normally distributed outcomes of blood lidocaine levels and time to lower lip numbness, an assessment of treatment difference was performed using Wilcoxon rank-sum tests with Proc NPAR1WAY (SAS 9.3). Statistical significance was set at a P value less than .05 for all outcomes. Results Forty-eight percent of subjects were women, half were Caucasian, 22% were African American, and 13% were Asian. Median age was 21 years (interquartile range [IQR], 20-22 yr), and median body weight was 147 lb (IQR, 130-170 lb). Median blood levels (44 blood samples) at 30 minutes were 1.19 μg/L per kilogram of body weight. Mean blood level differences of lidocaine for each patient were significantly lower after nerve block with the buffered drug compared with the non-buffered agent (P < .01). Mean score for pain on injection for nerve block (n = 46 scores) was 3.3 (standard deviation, 0.9). Seventy-eight percent of subjects reported lower or the same pain scores with the buffered drug; 61% of subjects reported a shorter time to lower lip numbness with the buffered drug. Conclusions Buffering 2% lidocaine with epinephrine can produce clinical outcomes favorable for subjects and clinicians without clinically detrimental peak blood lidocaine levels.

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