Clinical Outcomes of Buffered vs. Non-Buffered Lidocaine

Study Overview
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Brief Summary
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Anecdotal reports suggest buffering lidocaine with epinephrine just before intraoral injection reduces time of onset, results in a deeper anesthetic effect, without the sting with injection from a low pH. Additional data are needed to establish clinical important outcomes such as the peak blood level of lidocaine as compared to the non-buffered drug combination. Clinical pilot studies are proposed as the start of a series of investigations to support or modify the use of the buffered anesthetic for intraoral procedures.

Detailed Description
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Specific Aims: Compare blood levels at 30min post injection mandibular block with buffered and non- buffered 2% lidocaine with 1/100k epinephrine. Assess outcomes (pain levels during and post-injection, and onset of anesthesia symptoms) after buffered and non-buffered oral administration of 2% lidocaine with 1/100k epinephrine. Assess possible topical anesthetic properties of buffered and non-buffered oral administration of 2% lidocaine with 1/100k epinephrine Hypotheses: No difference in peak blood levels exist between buffered and non-buffered intraoral injection of 2% lidocaine with 1/100k epinephrine. Injection of buffered local anesthetic will produce less discomfort for the subject as compared to the drug with a low pH. Buffered local anesthetic will not produce a topical anesthetic effect Study Time Frame: 6 months Month One IRB approvals. Recruit volunteers as subjects. Prepare case-books. Months Two-Three Clinical Study Months Four-Five Analyze Lab, QOL data Month Six Prepare Abstracts, Papers Methods: Blinded, Randomized Clinical Design Recruit subjects with IRB approved consent at UNC Target enrollment 24 subjects Subjects will serve as their own controls in a cross-over AB/BA study design which is uniform within sequences, uniform within periods, and balanced Sample size justification: Primary interest is estimation of effect size from pilot study. 24 subjects should be sufficient to provide data to assess whether a larger study is warranted and provide estimates for sample size calculation for larger studies. Vital signs recorded: 10 min before, during at 30min intervals and after post-anesthetic clinical signs disappear: targeted lower lip no longer numb. Randomized subjects to be injected alternatively with 4cc of buffered and 4cc non-buffered oral administration of 2% lidocaine with 1/100k epinephrine. SAS will be used to create randomization schedules: The randomization will be performed first to type of drug given with a balanced randomization (half subjects buffered; half to non-buffered) An OMS resident, Dr Phero, will administer the drugs in the OMS clinic. In week One each subject would receive anesthetic to block the inferior alveolar and lingual N; Halstead or Gow-Gates techniques. No Buccal N. block. At least a week later injections would involve the alternate local anesthetic combination. Venous blood samples would be drawn from the antecubital fossa 30min post oral injection and assayed for blood lidocaine levels Timed Assessment: pre, during injection, and post-anesthetic for Clinical Onset of Anesthesia Signs: subject reported molar area numbness and numb lower lip on ipsilateral injected side. Assessment for pain level on injection; modified Likert-type scale In addition at each clinic session an assessment of a topical anesthetic effect on contralateral lower lip with 5 drops of the injected drug placed on the clinically dry lower lip mucosa, Outcome yes/no. Data Collection: UNC OMS clinic Venous blood samples (10cc) will be drawn from the antecubital fossa 30min post oral injection. Timed assessment pre, during injection, and post-anesthetic clinical Signs: molar area anesthesia, incisor area anesthesia, and numb lower lip for topical Data Collection/Analysis: Data will be managed by study staff. Data collection forms and questionnaires for clinical data will be developed to use Teleform for direct scanning input into an ACCESS database. Similar forms have been used in previous studies. All databases are stored on a password protected School of Dentistry server with specific group assignment. SAS will be used for database management and statistical analysis. Descriptive statistics are used to verify correct entry through range and logical checks.

Official Title
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Comparison of Buffered vs. Non-Buffered Lidocaine Used in Dental and Oral Surgical Procedures: Clinical Outcomes

Conditions
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Blood Levels of Buffered vs Non-buffered Lidocaine, Anesthetics, Local

Intervention / Treatment
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* Drug: Lidocaine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18-30 years ASA I Willingness to complete QOL instrument Willingness to participate in two sessions Exclusion Criteria: Allergy to lidocaine class of anesthetic drugs Local anesthetic drug use in past week Current symptoms teeth or oral mucosa

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 30 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Buffered Lidocaine<br>In week One each subject would receive anesthetic to block the inferior alveolar and lingual N; Halstead or Gow-Gates techniques. No Buccal N. block. Venous blood samples would be drawn from the antecubital fossa 30min post oral injection and assayed for blood lidocaine levels | Drug: Lidocaine<br>* See above<br>* Other names: Xylocaine;|
| Active Comparator: Non-buffered Lidocaine<br>In week One each subject would receive anesthetic to block the inferior alveolar and lingual N; Halstead or Gow-Gates techniques. No Buccal N. block. At least a week later injections would involve the alternate local anesthetic combination. Venous blood samples would be drawn from the antecubital fossa 30min post oral injection and assayed for blood lidocaine levels | Drug: Lidocaine<br>* See above<br>* Other names: Xylocaine;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Lidocaine Blood Levels 30 Minutes Post Injection | Lidocaine blood levels were obtained 30 minutes post injection micro g/L The difference between injection type- 95% confidence intervals for the difference between injection types was calculated. For the outcome variable, an assessment of treatment difference by subject, calculated as 1% Buffered minus 2% Non-Buffered, was performed using Wilcoxon rank sum tests with Proc NPAR1WAY (SAS v 9.3). Statistical significance was set as P < 0.05 for all outcomes. | 30 minutes post injection | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain Intensity Scores | Patients reported pain level immediately after injection of lidocaine via a Likert type scale where 1 = No Pain and 10 = Worst Pain Imaginable. For the outcome variable, an assessment of treatment difference by subject, calculated as 1% Buffered minus 2% Non-Buffered was performed. | Immediately after lidocaine injection | 
| Number of Minutes to Anesthesia Symptoms of Lower Lip | Patients were instructed to record the time when they experienced the initial indication of anesthesia signs in the lower lip. This was reported as the number of minutes following nerve block injection. For the outcome variable, an assessment of treatment difference by subject, calculated as 1% Buffered minus 2% Non-Buffered was performed. | Patient report of anesthesia symptom onset following injection | 
| Topical Anesthesia Effect Contralateral Lower Lip | Investigator will administer 5-6 drops of the lidocaine to the contralateral lower lip and immediately ask if signs of numbness are present on the lip. Patients reported presence of numbness lower lip-Yes or No | At time of administration | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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lidocaine, jaw