Buffered versus non-buffered lidocaine with epinephrine for subcutaneous implantable venous access devices insertion reduces pain: A randomized trial

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Published Jun 1, 2025
https://doi.org/10.62438/tunismed.v103i6.5309
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Vol. 103 No. 6 (2025): Tunis Med June 2025

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Imtinene Belaid
Department of Medical Oncology, Farhat Hached University Hospital, Sousse, Faculty of Medicine of Sousse, University of Sousse, Tunisie
Mohamed Kahloul
Department of Anesthesiology, Sahloul University Hospital, Sousse , Faculty of Medicine of Sousse, University of Sousse, Tunisie
Fahmi Ferhi
Department of Anesthesiology, Farhat Hached University Hospital , Sousse , Faculty of Medicine of Sousse, University of Sousse, Tunisie
Imen Ben Saida
Medical Intensive Care Unit, Research Laboratory LR12SP09 "Heart Failure", Farhat Hached University Hospital, Sousse, Faculty of Medicine of Sousse, University of Sousse, Tunisia
Chawki Jebali
SAMU 03 emergency medical assistance service, Sahloul University Hospital, Sousse, Faculty of Medicine of Sousse, University of Sousse, Tunisie
Hosni Khouaja
Department of Anesthesiology, Farhat Hached University Hospital , Sousse , Faculty of Medicine of Sousse, University of Sousse, Tunisie
Alaa Hafsa
Department of Anesthesiology, Farhat Hached University Hospital , Sousse , Faculty of Medicine of Sousse, University of Sousse, Tunisie
Khalil Tarmiz
Department of Anesthesiology, Sahloul University Hospital, Sousse , Faculty of Medicine of Sousse, University of Sousse, Tunisie
Slim Ben Ahmed
Department of Medical Oncology, Farhat Hached University Hospital, Sousse, Faculty of Medicine of Sousse, University of Sousse, Tunisie
Khaled Ben Jazia
Department of Anesthesiology, Farhat Hached University Hospital , Sousse , Faculty of Medicine of Sousse, University of Sousse, Tunisie

Abstract

Introduction: Implantable ports (Port-a-Caths) are a mainstay in the treatment of cancer patients. While these devices improve patient experience, their insertion can be painful.


Aim: To compare the analgesic efficacy of buffered and non-buffered lidocaine with epinephrine in reducing pain during Port-a-Caths insertion in cancer patients.


Methods: This study was a prospective, randomized, double-blind, controlled trial. One hundred twenty cancer patients scheduled for Port-a-Cath placement under local anesthesia were randomized to receive either buffered (pH=7.33) or non-buffered lidocaine with epinephrine (pH=3.50). The primary outcome was pain assessed during five procedural steps using a standardized 100-mm visual analog scale (VAS). Secondary outcomes included sensory block onset time and patient satisfaction.


 


Results: One hundred twenty patients were enrolled in this study, with sixty patients in each group. Mean pain scores during local anesthesia infiltration were significantly lower in the buffered lidocaine group (15.7 ± 7.6 mm) compared to the control group (46.9 ± 12.3 mm; p < 0.001). Mean VAS satisfaction scores were significantly higher in the buffered lidocaine group (95.75 ± 8 mm) compared to the control group (70.2 ± 20.1 mm; p < 0.001). Sensory block onset time, as determined by pinprick test, was significantly shorter in buffered lidocaine group (3.25 ± 1.3 min) compared to control group (5.5 ± 1.3 min; p < 0.001).


Conclusion: Alkalinizing lidocaine with epinephrine significantly reduced pain during Port-a-Cath placement in cancer patients, improving anesthesia quality and patient satisfaction.

Keywords:

Vascular Access Devices, pain , Anesthesia, neoplasms

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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