Palmon S C, Lloyd A T, Kirsch J R
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Anesth Analg. 1998 Feb;86(2):379-81. doi: 10.1097/00000539-199802000-00030.
Local anesthetics can produce pain during skin infiltration. We designed a randomized, prospective trial to determine whether needle gauge and/or solution pH affect pain during the intradermal infiltration of lidocaine. After approval by our institution's human studies review board, 40 healthy adult volunteers gave their consent to participate in this study. All of the volunteers randomly received four intradermal injections. Each volunteer was blinded as to the content of the intradermal injections and to which needle size was used for each injection. Each volunteer randomly received a 0.25-mL intradermal injection of the following four solutions: 1) lidocaine 2% administered through a 25-gauge needle (lido-25); 2) lidocaine 2% mixed with sodium bicarbonate (4 mL of 2% lidocaine plus 1 mL of sodium bicarbonate, pH 7.26) administered through a 25-gauge needle (lido-bicarb-25); 3) lidocaine 2% administered through a 30-gauge needle (lido-30); and 4) lidocaine 2% mixed with sodium bicarbonate (4 mL of 2% lidocaine plus 1 mL of sodium bicarbonate) administered through a 30-gauge needle (lido-bicarb-30). In each patient, the injection site was in the same region for each of the four injections. The skin wheal was tested for appropriate anesthesia using a 19-gauge needle on the skin wheal. A visual analog pain score was recorded after each intradermal injection. The pain scores were significantly higher in the lido-25 (3.2 +/- 0.2) group than in the lido-30 (2.5 +/- 0.3), lido-bicarb-25 (1.9 +/- 0.2), and lido-bicarb-30 (1.3 +/- 0.2) groups. The lido-bicarb-30 injection was also rated as less painful than the lido-30 injection. We found no differences between the lidobicarb-25 and the lido-bicarb-30 injections. Complete analgesia for the 19-gauge needle pain stimulus was achieved in all patients for each injection. We conclude that, overall, the pain intensity of an intradermal injection of 2% lidocaine is low. The addition of sodium bicarbonate to 2% lidocaine decreases the pain associated with an intradermal skin wheal, and although the use of a 30-gauge needle decreases the pain of injection, the addition of sodium bicarbonate seems to have a greater overall effect than needle size.
Forty volunteers randomly received four intradermal injections consisting of 2% lidocaine with or without sodium bicarbonate via a 25- or 30-gauge needle. The addition of bicarbonate had a greater overall effect than needle size in decreasing the pain associated with the intradermal injection of lidocaine.
局部麻醉药在皮肤浸润时可引起疼痛。我们设计了一项随机、前瞻性试验，以确定针的规格和/或溶液pH值是否会影响利多卡因皮内浸润时的疼痛。经我们机构的人体研究审查委员会批准后，40名健康成年志愿者同意参与本研究。所有志愿者均随机接受4次皮内注射。每位志愿者对皮内注射的内容以及每次注射所用的针的规格均不知情。每位志愿者随机接受以下四种溶液的0.25 mL皮内注射：1）通过25号针注射2%利多卡因（利多卡因-25）；2）通过25号针注射与碳酸氢钠混合的2%利多卡因（4 mL 2%利多卡因加1 mL碳酸氢钠，pH 7.26）（利多卡因-碳酸氢钠-25）；3）通过30号针注射2%利多卡因（利多卡因-30）；4）通过30号针注射与碳酸氢钠混合的2%利多卡因（4 mL 2%利多卡因加1 mL碳酸氢钠）（利多卡因-碳酸氢钠-30）。在每位患者身上，四次注射的部位均在同一区域。使用19号针在皮丘上测试皮肤皮丘的麻醉效果是否合适。每次皮内注射后记录视觉模拟疼痛评分。利多卡因-25组（3.2±0.2）的疼痛评分显著高于利多卡因-30组（2.5±0.3）、利多卡因-碳酸氢钠-25组（1.9±0.2）和利多卡因-碳酸氢钠-30组（1.3±0.2）。利多卡因-碳酸氢钠-30注射的疼痛程度也被评为比利多卡因-30注射轻。我们发现利多卡因-碳酸氢钠-25和利多卡因-碳酸氢钠-30注射之间没有差异。每次注射在所有患者中均实现了对19号针疼痛刺激的完全镇痛。我们得出结论，总体而言，皮内注射2%利多卡因的疼痛强度较低。向2%利多卡因中添加碳酸氢钠可减轻与皮内皮肤皮丘相关的疼痛，虽然使用30号针可减轻注射疼痛，但添加碳酸氢钠似乎比针的规格具有更大的总体效果。
40名志愿者随机接受4次皮内注射，注射物为含或不含碳酸氢钠的2%利多卡因，通过25号或30号针注射。在减轻与利多卡因皮内注射相关的疼痛方面，添加碳酸氢钠比针的规格具有更大的总体效果。
