Dilution of a mepivacaine-adrenaline solution in isotonic sodium bicarbonate for
reducing subcutaneous infiltration pain in ambulatory phlebectomy procedures: a
randomized, double-blind, controlled trial.
Author(s): Moro L(1), Serino FM(2), Ricci S(1), Abbruzzese G(1), Antonelli-Incalzi R(1).
Affiliation(s): Author information:
(1)Department of Geriatrics, University Campus Bio-Medico, Rome, Italy.
(2)Department of Geriatrics, University Campus Bio-Medico, Rome, Italy.
Electronic address: f.serino@unicampus.it.
Publication date & source: 2014, J Am Acad Dermatol. , 71(5):960-3
BACKGROUND: Varicose veins are treated under local infiltration anesthesia.
Literature shows that adding sodium bicarbonate reduces the pain associated with
local infiltration anesthesia. Nonetheless, sodium bicarbonate is underused.
OBJECTIVE: We sought to assess if the use of a solution of mepivacaine 2% plus
adrenaline with sodium bicarbonate 1.4% results in less pain associated with
local infiltration anesthesia preceding ambulatory phlebectomies, compared with
standard preparation diluted with normal saline.
METHODS: In all, 100 adult patients undergoing scheduled ambulatory phlebectomy
were randomized to receive either a solution of mepivacaine chlorhydrate 2% plus
adrenaline in sodium bicarbonate 1.4% or a similar solution diluted in normal
saline 0.9%.
RESULTS: Median pain scores associated with local infiltration anesthesia
reported in the intervention and control groups were 2 (SD=1.6) and 5 (SD=2.0)
(P<.0001), respectively. A general linear model with bootstrapped confidence
intervals showed that using the alkalinized solution would lead to a reduction in
pain rating of about 3 points.
LIMITATIONS: Patients were not asked to distinguish the pain of the needle stick
from the pain of the infiltration. Moreover, a complete clinical study of
sensitivity on the infiltrated area was not conducted.
CONCLUSIONS: Data obtained from this study may contribute to improve local
infiltration anesthesia in ambulatory phlebectomy and other phlebologic
procedures.
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