Ensuring patient comfort when performing pain procedures is one of the best ways to make sure your patient will return for future treatments. This is especially true for patients who have a very low tolerance for pain. In anesthesia, we often use 1% lidocaine through a TB syringe to numb the skin prior to placement of an I.V. However, 1% lidocaine has a pH of 6.5 and therefore causes a sting or burning sensation prior to the onset of analgesia. As pain physicians, we often must infiltrate many areas of skin which can cause a great deal of discomfort for the patient. Below is the non-sting formulation we use for skin infiltration now. We have noticed a dramatic decrease in the incidence of complaints during infiltration. We also suggest always initially infiltrating using the smallest needle possible. We use a 30gauge for initial infiltration.

“Non Sting Formula”

4 cc 4% lidocaine

24 cc of Lactated Ringers

2 cc Bicarbonate

Note this must be mixed daily to ensure sterility and to avoid precipitation.

The origin of this formula is unknown but is often presented at many pain courses. My source was a course in which a paper by John Mathis, MD stated this formula. I am not aware of any copyrights to this information and therefore publish it in the hope that we can all better serve our patients.

Rainier Guiang , MD