Institutional members access full text with Ovid®

Share this article on:

A Randomized Trial of Buffered Versus Nonbuffered Lidocaine With Epinephrine for Cervical Loop Excision

Kizer, Nora T. MD, MSCI1; Zhao, Qiuhong MS2; Peipert, Jeffrey F. MD, PhD2; Ioffe, Yevgeniya MD1; Massad, L. Stewart MD1

Journal of Lower Genital Tract Disease: January 2014 - Volume 18 - Issue 1 - p 8–12
doi: 10.1097/LGT.0b013e31828deffd
Original Articles

Objective Our study evaluated whether buffering reduces pain from lidocaine injection for loop electrosurgical excisional procedures (LEEPs) of the cervix when compared to unbuffered lidocaine.

Methods Women undergoing outpatient LEEPs were randomized to receive either buffered or unbuffered lidocaine. Participants, caregivers, and statisticians were blinded to treatment allocation. Pain was categorized as injection, procedure, or cramping pain. Severity of pain was reported using a Likert visual analog scale and compared using Mann-Whitney tests.

Results Twenty-eight subjects received buffered lidocaine and 24 subjects received unbuffered lidocaine. The 2 groups were similar in regard to age, race, previous LEEP, anesthetic volume used, and loop size. Mean scores were similar between the nonbuffered and buffered groups for injection pain (25 vs 19, p = .13), procedure pain (27 vs 19, p = .08), and cramping pain (19 vs 18, p = .86).

Conclusions Pain scores with subepithelial lidocaine plus epinephrine for LEEP are low and are not significantly reduced by buffering the anesthetic.

The use of buffered lidocaine does not reduce pain experienced by women undergoing outpatient loop electrosurgical excisional procedures when compared to unbuffered lidocaine.

Divisions of 1Gynecologic Oncology and 2Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, Saint Louis, MO

Reprint requests to: Nora T. Kizer, MD, MSCI, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, 660 S Euclid Ave, Saint Louis, MO 63110. E-mail:

Funding for this study was provided by the Division of Gynecologic Oncology through the Department of Obstetrics and Gynecology at Washington University School of Medicine in Saint Louis, MO. All authors have no other financial disclosures.

Copyright © 2014 by the American Society for Colposcopy and Cervical Pathology