Buffer added to steroid lidocaine hand injections linked with less pain for some patients
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BOSTON — Adding sodium bicarbonate to steroid lidocaine injections for patients with certain hand conditions who also have high anxiety about undergoing hand injections may provide a less painful injection experience, results showed.
At the American Society for Surgery of the Hand Annual Meeting, Christopher J. Lama, MD, MS, BS, presented results of a randomized controlled trial he and his colleagues at Brown University performed in which 250 adult patients who already were undergoing injections for hand conditions, such as trigger finger and carpal tunnel syndrome, were randomized into two injection groups.
A group of 125 patients received betamethasone lidocaine hand injections that were buffered with sodium bicarbonate and a group of 125 patients received unbuffered betamethasone lidocaine hand injections. Three providers performed the injections.
Both groups underwent a baseline anxiety assessment with a 10-point scale (0 = not being anxious; 10 = being extremely anxious) to determine their anxiety level regarding the injection, Lama said.
Patients had their pain measured during, as well as at 1 minute after the injection was administered as part of the study using a 10-point VAS for pain.
“There were no differences found in baseline characteristics between the two groups apart from baseline anxiety. We did have differences in that the buffered group showed a lower pre-injection anxiety score compared to the unbuffered group. Overall, there were no differences found in pain during or after the injection for any pathology when comparing buffered and unbuffered injections ” Lama said.
However, after stratifying patients based on whether they had low or high anxiety about the injections, “we did find that anxiety did moderate the effect of a buffered injection on pain,” he said.
Notably, patients with high anxiety who received the bicarbonate buffer experienced significantly less pain vs. patients who did not, according to the findings.
“We also found that within females, pain during the injection was significantly higher in the nonbuffered group compared to the buffered group,” Lama said.
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Lama CJ, et al. Paper 2. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 29-Oct. 1, 2022; Boston.
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