Procedural Pain
72. C.T., a 26-year-old woman, injured her left knee during a fall while skiing. After immobilizing her left knee and using ice therapy, most of her swelling has subsided. She is now seen in the outpatient surgical center for an arthroscopic evaluation of her knee. She is very concerned that the lidocaine that is to be used to anesthetize her knee is going to produce pain, because she has had a bad experience with regional lidocaine injections. What can be recommended to reduce the pain associated with lidocaine infiltration?
Lidocaine injection is quite acidic and can produce local irritation and pain during the infiltration procedure before the anesthetic effect takes place. Because this is a common complaint, C.T.'s concerns should be taken seriously. A simple solution is to neutralize the lidocaine injection solution by adding 1 mL of 1 mEq/mL sodium bicarbonate to 9 mL of 1% to 2% lidocaine before injecting C.T.238,239 Because lidocaine is stable over a wide range of pH values, the bicarbonate will not reduce its efficacy of local anesthetic blockade. This technique should not be used with other local anesthetics, however, because they may be subject to rapid degradation by basic agents.
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