Davies Robert John
Emergency Department, The Tweed Hospital, Tweed Heads, New South Wales, Australia.
Emerg Med (Fremantle). 2003 Feb;15(1):81-8. doi: 10.1046/j.1442-2026.2003.00413.x.
To review the evidence that buffering of local anaesthetics with sodium bicarbonate reduces the pain of injection whilst not affecting efficacy.
Medline search from 1966 to December 2001. Articles in all languages were included. Bibliographies were examined for papers.
The search identified 63 publications. All were retrieved. Of these, 22 were human prospective randomized controlled trials directly assessing the pain of infiltration. Three papers were based on observations. No case series, case reports, or retrospective studies were identified. One animal study was found.
The evidence is that buffering with sodium bicarbonate significantly reduces the pain of local anaesthetic injection. The buffered solutions retain the efficacy of local anaesthetics and are stable in the mixtures used in the trials. Adrenaline-containing buffered solutions need refrigeration in closed containers for storage. Buffering will be particularly useful where pain of local anaesthetic injection may not be well tolerated such as in large areas of infiltration, sensitive areas such as the face and in children. It is recommended that sodium bicarbonate and tables of stable dilutions are readily available in the emergency department to facilitate this.
回顾关于用碳酸氢钠缓冲局部麻醉药可减轻注射疼痛而不影响疗效的证据。
检索1966年至2001年12月的Medline。纳入所有语言的文章。查阅参考文献以获取相关论文。
检索到63篇出版物。全部获取。其中，22篇是直接评估浸润疼痛的人体前瞻性随机对照试验。3篇基于观察。未识别出病例系列、病例报告或回顾性研究。找到1项动物研究。
有证据表明用碳酸氢钠缓冲可显著减轻局部麻醉药注射的疼痛。缓冲溶液保留了局部麻醉药的疗效，且在试验所用混合物中稳定。含肾上腺素的缓冲溶液需在密闭容器中冷藏保存。在局部麻醉药注射疼痛可能难以耐受的情况下，如大面积浸润、面部等敏感部位以及儿童，缓冲尤为有用。建议急诊科随时备有碳酸氢钠和稳定稀释表以方便操作。
