The effect of needle gauge and lidocaine pH on pain during intradermal injection

Sally C. Palmon, Aaron T. Lloyd, Jeffrey Kirsch

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

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 tido-bicarb-30 injection was also rated as less painful than the lido-30 injection. We found no differences between the lido-bicarb-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. Implications: 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.

Original languageEnglish (US)
Pages (from-to)379-381
Number of pages3
JournalAnesthesia and Analgesia
Volume86
Issue number2
DOIs
StatePublished - 1998
Externally publishedYes

Fingerprint

Intradermal Injections
Lidocaine
Needles
Sodium Bicarbonate
Pain
Injections
Volunteers
Skin
Bicarbonates
Local Anesthetics
Analgesia
Healthy Volunteers
Anesthesia

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

The effect of needle gauge and lidocaine pH on pain during intradermal injection. / Palmon, Sally C.; Lloyd, Aaron T.; Kirsch, Jeffrey.

In: Anesthesia and Analgesia, Vol. 86, No. 2, 1998, p. 379-381.

Research output: Contribution to journalArticle

@article{b93f88d259a440308d5e8f8c9429966f,
title = "The effect of needle gauge and lidocaine pH on pain during intradermal injection",
abstract = "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 tido-bicarb-30 injection was also rated as less painful than the lido-30 injection. We found no differences between the lido-bicarb-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. Implications: 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.",
author = "Palmon, {Sally C.} and Lloyd, {Aaron T.} and Jeffrey Kirsch",
year = "1998",
doi = "10.1097/00000539-199802000-00030",
language = "English (US)",
volume = "86",
pages = "379--381",
journal = "Anesthesia and Analgesia",
issn = "0003-2999",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - The effect of needle gauge and lidocaine pH on pain during intradermal injection

AU - Palmon, Sally C.

AU - Lloyd, Aaron T.

AU - Kirsch, Jeffrey

PY - 1998

Y1 - 1998

N2 - 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 tido-bicarb-30 injection was also rated as less painful than the lido-30 injection. We found no differences between the lido-bicarb-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. Implications: 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.

AB - 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 tido-bicarb-30 injection was also rated as less painful than the lido-30 injection. We found no differences between the lido-bicarb-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. Implications: 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.

UR - http://www.scopus.com/inward/record.url?scp=0031952534&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031952534&partnerID=8YFLogxK

U2 - 10.1097/00000539-199802000-00030

DO - 10.1097/00000539-199802000-00030

M3 - Article

VL - 86

SP - 379

EP - 381

JO - Anesthesia and Analgesia

JF - Anesthesia and Analgesia

SN - 0003-2999

IS - 2

ER -