Abstract
Objective: This prospective, pilot randomized double-blind study aimed to compare the effects of buffered and non-buffered xylocaine solutions on injection pain and anesthesia effectiveness in patients undergoing arteriovenous fistula surgery.Material and methods: A total of 100 adult patients meeting inclusion criteria undergoing arteriovenous fistula surgery were included in the study. They were split into two groups at random. The control group received 1% xylocaine dissolved in 5 ml distilled water, while the intervention group received sodium bicarbonate mixed with 1% xylocaine solution as a local anesthetic. The patients were asked to rate the pain of first and subsequent injections on a visual analog scale (VAS). Besides, the need for extra analgesia was investigated. The mean and standard deviation of the data was determined.Results: During both the first and subsequent injections, the alkalinized local anesthetic group showed substantially lower VAS scores. In the alkalinized local anesthetic group, anesthesia satisfaction was also more than three times higher. Furthermore, the non-alkalinized group's mean analgesic requirement was higher than the intervention group.Conclusion: Our findings support the effectiveness of the alkalinized local anesthetic solution in minimizing injection pain and increasing anesthesia duration and overall patient's surgical experience in terms of anesthesia satisfaction score.
Highlights
A patient with end-stage renal failure requires hemodialysis access most of all [1]
The control group received 1% xylocaine dissolved in 5 ml distilled water, while the intervention group received sodium bicarbonate mixed with 1% xylocaine solution as a local anesthetic
In the alkalinized local anesthetic group, anesthesia satisfaction was more than three times higher
Summary
A patient with end-stage renal failure requires hemodialysis access most of all [1]. Arteriovenous fistulas (AVF) have the lowest rates of morbidity and mortality of all the vascular access alternatives [2]. The Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines have emphasized the arteriovenous fistula as the first initiative because of its superior patency, lower complication rate, and lower healthcare expense [3]. Most vascular surgeons tend to operate under local anesthesia due to the complications and risks involved with other types of anesthesia in such patients. Pain from lignocaine injections is influenced by surgical experience, needle gauge, rate and volume of infiltration, temperature, and most importantly, the acidic pH of the solution [5]
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