BUFFERED LIDOCAINE FOR SKIN INFILTRATION PRIOR TO HEMODIALYSIS

This study compared the effects of buffered versus unbuffered lidocain e when used as local anesthetic in preparation for cannulation of the arterial and venous sites of children requiring hemodialysis. The subj ects for this study were seven children, ages 6-18 years, observed dur ing 101 dialysis treatments. For each subject undergoing hemodialysis on a given day, one syringe containing 1% lidocaine (L) and one contai ning buffered lidocaine (BL) were prepared. The BL solution was prepar ed by adding 2 mL of 8.4% sodium bicarbonate to 20 mL of 1% lidocaine just prior to use. The choice of local anesthetic used for cannulation of the arterial or venous site was randomly assigned to be either L o r BL. Nurses, raters, and subjects were blind to contents of the syrin ge. The procedures for piercing the skin, pausing, and infiltration we re standardized, as was the volume administered. Speed of injection wa s not controlled. Comparisons of self-reported pain and behavioral obs ervations for L versus BL revealed no significant differences for pain or infiltration or pain of cannulation. Technique variables such as t he speed of injection, which tended to be very slow for these children , appear to significantly influence infiltration pain and the relative merits of buffering.