Abstract
We read with interest the article by Lee et al. on the use of buffered local anesthetic [LA] for minor hand and wrist surgery. 1 It is indeed clinically important to explore various efficacious steps to reduce pain while giving LA injection. Combining more than one practice could be a prudent strategy to enhance outcome.
In this context, we believe, two other methods described in literature, one that studied warming the LA solution and the other that advocated slow speed of administration of LA may be considered and combined to significantly reduce the pain during LA injection.
In a systemic review and meta-analysis of 18 studies including 831 patients, Hogan et al. concluded that warming of LA to body temperature leads to less pain. 2 Lundbom et al., in a randomized double blinded trail on 36 healthy volunteers, noted that VAS score for the LA heated to body temperature was significantly lower than the lidocaine at the room temperature [p = 0.004]. 3 Another randomized control trial study done on 32 young healthy adults has shown a synergistic effect on pain reduction when buffered LA was injected after warming. 4 In the study, the pain score as measured on visual analog score with warm and buffered LA use was significantly lower than other solution [vs warm: p = 0.0005; versus buffered: p = 0.0028; vs room temperature: p = 0.0001].
The rate of administration of LA was found to have a significant impact on pain reduction in a prospective study conducted on 42 adult volunteers in a study by Scarfone et al. 5 The study concluded that slow administration of LA [30 s vs 5 s in the rapid group] has a greater impact on pain perception than buffered LA.
