Skip to main content

Local anesthesia with lidocaine, buffered lidocaine, warmed buffered lidocaine, slow injection of lidocaine: publishing the results of perforating my own arm

I have done procedures using local anesthesia with subcutaneous lidocaine for over 20 years, and by the look on peoples' faces, I know that lidocaine stings. About 10 years ago I heard that adding a small amount of bicarbonate to the lidocaine took the sting away, but I never really had a chance to try it since my clinic never had any bicarbonate around. Just recently I went over the literature about reducing pain with injections and read that slowing the injection and warming the lidocaine is also effective in reducing the sting.

The pharmacy of my home hospital is very understanding and cooperative and they treated me to a vial of lidocaine 2%, a vial of 8.4% bicarb and all the insulin syringes I wanted. The insulin syringes have 28 g needles which are only slightly thicker than an eyelash so hardly hurt at all. I buffered the lidocaine with 1 part bicarb to 9 parts lidocaine. (It turns out that despite concerns that lidocaine would not be stable in a buffered solution, it actually is, if kept refrigerated: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827006/) I injected about 0.1 ml subcutaneously into my left forearm for each variable.

My conclusions:
1. Lidocaine stings when injected quickly.
2. It pretty much doesn't sting at all if it is injected slowly, but it is very difficult to inject it slowly because a tiny syringe wants to give way quickly when pressure is applied to the plunger. I suspect I could get good at this if I practiced and used two hands.
3. After a little bit of lidocaine goes in, the rest of the injection, if not given too quickly, is painless.
4. Buffered lidocaine is less painful than straight lidocaine if injected quickly, and painless if warmed and injected slowly.
5. Warmed lidocaine (just warmed in the hands for a little while) injected slowly is quite painless. Warming it matters.

Comments

Popular posts from this blog

How to make your own ultrasound gel (which is also sterile and edible and environmentally friendly) **UPDATED--NEW RECIPE**

I have been doing lots of bedside ultrasound lately and realized how useful it would be in areas far off the beaten track like Haiti, for instance. With a bedside ultrasound (mine fits in my pocket) I could diagnose heart disease, kidney and gallbladder problems, various cancers as well as lung and intestinal diseases. Then I realized that I would have to take a whole bunch of ultrasound gel with me which would mean that I would have to check luggage, which is a real pain when traveling light to a place where luggage disappears. I heard that you can use water, or spit, in a pinch, or even lotion, though oil based coupling media apparently break down the surface of the transducer. Or, of course, you can just use ultrasound gel. Ultrasound requires an aqueous interface between the transducer and the skin or else all you see is black. Ultrasound gel is a clear goo, looks like hair gel or aloe vera, and is made by several companies out of various combinations of propylene glycol, glyce

Ivermectin for Covid--Does it work? We don't know.

  Lately there has been quite a heated controversy about whether to use ivermectin for Covid-19.  The FDA , a US federal agency responsible for providing unbiased information to protect people from harmful drugs, foods, even tobacco products, has said that there is not good evidence of ivermectin's safety and effectiveness in treating Covid 19, and that just about sums up what we truly know about ivermectin in the context of Covid. The CDC, Centers for Disease Control, a branch of the department of Health and Human Services, tasked with preventing and treating disease and injury, also recently warned  people not to use ivermectin to treat Covid outside of actual clinical trials. Certain highly qualified physicians, including ones who practice critical care medicine and manage many patients with severe Covid infections in the intensive care unit vocally support the use of ivermectin to treat Covid and have published dosing schedules and reviews of the literature supporting it for tr

Old Fangak, South Sudan--Bedside Ultrasound and other stuff

I just got back from a couple of weeks in Old Fangak, a community of people living by the Zaraf River in South Sudan. It's normally a small community, with an open market and people who live by raising cows, trading on the river, fishing and gardening. Now there are tens of thousands of people there, still displaced from their homes by the civil war which has gone on intermittently for decades. There are even more people now than there were last year. There is a hospital in Old Fangak, which is run by Jill Seaman, one of the founders of Sudan Medical relief and a fierce advocate for treatment of various horrible and neglected tropical diseases, along with some very skilled and committed local clinical officers and nurses and a contingent of doctors, nurses and support staff from Medecins Sans Frontieres (Doctors Without Borders, also known as MSF) who have been helping out for a little over a year. The hospital attempts to do a lot with a little, and treats all who present ther