Knowledge, Attitudes, and Perceptions of Advanced Practice Providers Regarding Use of Buffered Versus Non-Buffered Lidocaine Hydrochloride 1% for Interventional Procedural Pain Management in Adults

Abstract

The purpose of this study was to examine: a) knowledge, attitudes, and perceptions of advanced practice providers (APPs) - nurse practitioners (NPs), and physician assistants (PAs) - regarding the use of buffered versus non-buffered lidocaine hydrochloride 1% for interventional procedural pain management in adults; and b) relationships among socio-demographic variables and knowledge, attitudes, and perceptions of APPs regarding use of buffered versus non-buffered lidocaine hydrochloride 1% within the clinical setting.

Procedural pain management by APPs requires adequate knowledge regarding appropriate choice of local anesthetic agent, including buffered versus non-buffered lidocaine hydrochloride 1%. Although non-buffered lidocaine hydrochloride 1% pH is more acidic than human tissue pH, it is often used by APPs.

This descriptive study used a survey design. Inclusion criteria were: 1) ≥ 18 years of age; 2) APP: NP and PA; c) administer local anesthetics for interventional procedural pain management in adults; 3) employed by a pain center organization with sites in Arizona and Florida; 4) DEA licensed and board certified; 5) computer access to use the electronic platform of SurveyMonkeyTM; and 6) active pain center organization encrypted email address. The investigator-created 48-item survey had 4 sections: socio-demographics; knowledge; attitudes; and perceptions. The survey contained Likert-type scales and 2 open-ended questions. After Georgetown University Institutional Review Board approval, study staff administered the survey via SurveyMonkeyTM. Descriptive statistics and SPSS (version 25, 2016) were utilized for data analysis. The survey was sent to all 53 eligible APPs. Twenty-nine participants returned completed surveys giving a 54.7% response rate. Mean knowledge score for interventional pain management in adults was 2.8 (SD=1.0) (2 = “moderate knowledge”; 3 = “good knowledge”). Although most participants (68.9%) agreed that buffered lidocaine hydrochloride 1% was effective, only 44.8% reported it more effective than the non-buffered formulation. Most participants (72.4%) reported needing more education regarding appropriate use of buffered lidocaine hydrochloride 1%, which is an important finding.