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

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.