Lidocaine With Epinephrine vs. Bupivacaine With Epinephrine as Local Anesthetic Agents in Wide-awake Hand Surgery
Lidocaine With Epinephrine vs. Bupivacaine With Epinephrine as Local Anesthetic Agents in Wide-awake Hand Surgery: an Outcome Study of Patients' Pain Perception.
This study is focused on comparing patients' pain scores on a visual analogue scale (VAS)
and the difference in analgesics use post-operatively (with the same prescription defining
only the maximum frequency) between lidocaine with epinephrine & bupivacaine with
epinephrine as local anesthetics in wide-awake hand surgery. The investigators' hypothesis
states that a longer acting local anesthetic agent (bupivacaine) would be able to provide
better postoperative pain relief demonstrated by lower pain scores on VAS and less
analgesics use (as will be recorded on the patient's log). This will be mainly obvious in
the first 24 hours postoperative period when the pain is usually at maximum levels and
starts to decline thereafter. If the investigators' hypothesis is true, this may potentially
change practices of many hand surgeons towards the routine use of longer acting local
anesthetics particularly in wide-awake hand surgery, and perhaps could be extrapolated to
other surgical specialties. Further, a reduction in postoperative analgesics use would be of
paramount clinical importance, as it would reduce their potential side effects.
The purpose of this study is to better understand the differences of two commonly used local
anesthetics in carpal tunnel surgery. This study will explore the differences in terms of
patient satisfaction during surgery (measured on VAS), pain after surgery (measured on VAS),
and the need for pain medications after surgery (patients will annotate on a log given to
them the time of the medication taken if needed for analgesia).
Wide awake hand surgery (freezing your limb while being fully awake) has recently been
popularized as being faster and safer for patients compared to hand surgery under general
anesthesia or with sedation. Advantages include fast recovery and no risks of general
In order to freeze the wrist to undergo carpal tunnel surgery, a local anesthetic is
injected into the nerves of the wrist. Among the most commonly used anesthetic agents are
Lidocaine (shorter duration of anesthesia) and Bupivacaine (longer duration of anesthesia).
Until now, no enough evidence to support using one anesthetic agent over the other.
Furthermore, no previous studies looked at the perception of pain from patient's
perspectives when using different anesthetic agents.
There will be NO change in the standard medical care that patients will receive whether or
not patients decide to participate in the study. Patients that join the study will receive
the same anesthetic agents used in those procedures as patients who decide not to
participate. The only difference will be collecting clinical data from participants and
asking participants to complete two questionnaires regarding the surgical experience, and
the perceived level of pain during the two days that follow surgery. As well, participants
will be asked to keep a simple log of the pain medications that are consumed during the two
days after the surgery. Patients' total participation time should take no more than 30
Patients' decision to participate in this study will help doctors in the future to decide
which of these two used anesthetic agents (Lidocaine or Bupivacaine) gives patients the best
experience during surgery. As well, it will help reduce the pain that some patients
experience after surgery, as well as reduce the need for pain medications after surgery.
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome, Anesthetics, Local, Pain Perception, Pain Measurement, Analgesia, Lidocaine, Bupivacaine
St. Mary's Research Center, Canada
Dr Mario Luc
Wildin C, Dias JJ, Heras-Palou C, Bradley MJ, Burke FD. Trends in elective hand surgery referrals from primary care. Ann R Coll Surg Engl. 2006 Oct;88(6):543-6.
Angermann P, Lohmann M. Injuries to the hand and wrist. A study of 50,272 injuries. J Hand Surg Br. 1993 Oct;18(5):642-4.
Larsen CF, Mulder S, Johansen AM, Stam C. The epidemiology of hand injuries in The Netherlands and Denmark. Eur J Epidemiol. 2004;19(4):323-7.
Neill RS. Postoperative analgesia following brachial plexus block. Br J Anaesth. 1978 Apr;50(4):379-82.
Ganzberg S, Kramer KJ. The use of local anesthetic agents in medicine. Dent Clin North Am. 2010 Oct;54(4):601-10. doi: 10.1016/j.cden.2010.06.001. Review.
Alhelail M, Al-Salamah M, Al-Mulhim M, Al-Hamid S. Comparison of bupivacaine and lidocaine with epinephrine for digital nerve blocks. Emerg Med J. 2009 May;26(5):347-50. doi: 10.1136/emj.2008.062497.
Conolly WB, Berry FR. The place of peripheral nerve blocks in reconstructive hand surgery. Hand. 1977 Jun;9(2):157-9.
Lalonde DH. Reconstruction of the hand with wide awake surgery. Clin Plast Surg. 2011 Oct;38(4):761-9. doi: 10.1016/j.cps.2011.07.005. Review.
Pratap JN, Shankar RK, Goroszeniuk T. Co-injection of clonidine prolongs the anesthetic effect of lidocaine skin infiltration by a peripheral action. Anesth Analg. 2007 Apr;104(4):982-3.
Reinhart DJ, Stagg KS, Walker KG, Wang WP, Parker CM, Jackson HH, Walker EB. Postoperative analgesia after peripheral nerve block for podiatric surgery: clinical efficacy and chemical stability of lidocaine alone versus lidocaine plus ketorolac. Reg Anesth Pain Med. 2000 Sep-Oct;25(5):506-13.
Thomson CJ, Lalonde DH. Randomized double-blind comparison of duration of anesthesia among three commonly used agents in digital nerve block. Plast Reconstr Surg. 2006 Aug;118(2):429-32.
Reichl M, Quinton D. Comparison of 1% lignocaine with 0.5% bupivacaine in digital ring blocks. J Hand Surg Br. 1987 Oct;12(3):375-6.
Gorzack A. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Lignocaine or bupivacaine for digital ring block. J Accid Emerg Med. 1998 Sep;15(5):353.
Valvano MN, Leffler S. Comparison of bupivacaine and lidocaine/bupivacaine for local anesthesia/digital nerve block. Ann Emerg Med. 1996 Apr;27(4):490-2.
Nyström A, Lindström G, Reiz S, Hanel DP. Bupivacaine: a safe local anesthetic for wrist blocks. J Hand Surg Am. 1989 May;14(3):495-8.
Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain. 2003 Sep;4(7):407-14.
Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979 Mar;86(2):420-8. Review.