Sodium bicarbonate alkalinization of local anesthetics for peripheral nerve blocks: A systematic review
Authors' conclusion
This review shows that alkalinization may accelerate onset time in peripheral nerve blocks, particularly with lidocaine (lignocaine) and most consistently for motor onset, but the effect is variable, agent-specific, and supported by evidence of low-to-moderate certainty.
Study context
- Population
- Patients receiving single-shot peripheral nerve blocks18 studies
- Comparison
- Alkalinization vs Non-alkalinised
- Outcome
- Onset time, duration, or block quality
Methodological detailsstructured narrative synthesis, Risk of bias predominantly some concerns; incomplete final pH reporting in several studies limited intervention fidelity
- Structured narrative synthesis
- Risk of bias predominantly some concerns; incomplete final pH reporting in several studies limited intervention fidelity
Pooled result
As reported in the abstract
Onset time
Faster onset in at least one outcome after alkalinization (studies with group-comparable onset data)
13 of 16 studies
Further pooled results
Block duration
- Effects on block duration heterogeneous
Block quality
- Block quality findings inconsistent
Original publication
Sodium bicarbonate alkalinization of local anesthetics for peripheral nerve blocks: A systematic review. J Clin Anesth. Published 30 June 2026. doi:10.
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