Assessing the Efficacy of Buffered Versus Nonbuffered Lidocaine in Dental Extractions: A Double-Blinded Randomized Controlled Trial

Yotom Rabinowitz; Skyler Williams; Reese R Triana; Md Tareq Ferdous Khan; Kassie J Hooker; Aayush Dubey; Anshya Tewari; Eric Holmes; James A Phero

doi:10.1016/j.joms.2024.03.008

Assessing the Efficacy of Buffered Versus Nonbuffered Lidocaine in Dental Extractions: A Double-Blinded Randomized Controlled Trial

J Oral Maxillofac Surg. 2024 Mar 13:S0278-2391(24)00156-3. doi: 10.1016/j.joms.2024.03.008. Online ahead of print.

Authors

Yotom Rabinowitz¹, Skyler Williams², Reese R Triana³, Md Tareq Ferdous Khan⁴, Kassie J Hooker⁵, Aayush Dubey⁶, Anshya Tewari⁶, Eric Holmes⁷, James A Phero⁸

Affiliations

¹ Assistant Professor, Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA.
² Chief Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH.
³ MBA Student, Boston University, Questrom School of Business, Boston, MA.
⁴ Associate Professor, Department of Mathematics and Statistics, Cleveland State University, Cleveland, OH.
⁵ Project Administrator, Department of Chemistry and Chemical Biology, Rensselaer Polytechnic Institute, Troy, NY.
⁶ Student Research Volunteer, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH.
⁷ Clinical Research Coordinator, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH.
⁸ Assistant Professor, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH. Electronic address: pheroja@ucmail.uc.edu.

PMID: 38554734
DOI: 10.1016/j.joms.2024.03.008

Abstract

Background: Injections using buffered lidocaine may decrease discomfort, have a quicker onset, and be a more efficacious local anesthetic. Previous studies have been inconclusive in the oral context.

Purpose: To address if bicarbonate buffered 2% lidocaine can decrease pain from the use of local anesthesia, has a quicker onset time, and is more efficacious.

Study design: The design was a single-center double-blinded randomized control trial, set in an outpatient oral and maxillofacial clinic housed in the University of Cincinnati Medical Center. Inclusion criteria for the study were patients requiring a single tooth extraction due either to caries or periodontal disease.

Predictor variable: The predictor variable was the local anesthetic used either nonbuffered 2% lidocaine with 1:100,000 epinephrine (control) or bicarbonate buffered 2% lidocaine with 1:100,000 epinephrine (study) was randomly assigned.

Main outcome variables: Primary outcome variables were injection pain score, and postoperative pain, time to anesthetic onset, and the number of rounds of injections required to achieve adequate anesthesia.

Covariates: The covariates were jaw involved, age, sex, and race, American Society of Anesthesiologists score, body mass index, current tobacco use, history of psychiatric illness, chronic pain, and preoperative pain score.

Analyses: Test statistics were calculated using Wilcoxon rank-sum test, Kruskal-Wallis test, Spearman rank correlation test, χ² test for bivariate analyses, and Fisher's exact test. P values ≤ .05 were considered statistically significant.

Results: The final sample was 114 subjects. The mean age of the sample was 42.97 years, standard deviation ±13.43 years. The sample was 39.47% male. The racial demographics were Caucasian (62.28%) and African American (33.33%). Buffered lidocaine did not have a statistically significant relationship with any of the outcomes. The jaw involved had a statistically significant association to the injection pain score (P value = .006), and the number of rounds of anesthetic required (P value = .047). Age showed a statistically significant association to injection pain score (P value = .032), and the number of rounds of anesthetic required (P value = .027). Finally, preoperative pain had a statistically significant relationship with injection pain score (P value = < .001).

Conclusion and relevance: In this study, bicarbonate buffered lidocaine did not exhibit any discernible advantages over nonbuffered lidocaine for any study outcomes.