Lidocaine With Epinephrine Versus Bupivacaine With Epinephrine as Local Anesthetic Agents in Wide-Awake Hand Surgery: A Pilot Outcome Study of Patient's Pain Perception

Julian Diaz-Abele; Mario Luc; Alina Dyachenko; Salah Aldekhayel; Antonio Ciampi; Jane McCusker

doi:10.1016/j.jhsg.2019.09.004

Lidocaine With Epinephrine Versus Bupivacaine With Epinephrine as Local Anesthetic Agents in Wide-Awake Hand Surgery: A Pilot Outcome Study of Patient's Pain Perception

J Hand Surg Glob Online. 2019 Oct 31;2(1):1-6. doi: 10.1016/j.jhsg.2019.09.004. eCollection 2020 Jan.

Authors

Julian Diaz-Abele¹, Mario Luc², Alina Dyachenko³, Salah Aldekhayel⁴, Antonio Ciampi⁵, Jane McCusker⁵

Affiliations

¹ Division of Plastic and Reconstructive Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
² Division of Plastic and Reconstructive Surgery, McGill University St. Mary's Hospital, Montreal, Quebec, Canada.
³ Centre Hospitalier de l'Université de Montreal Research Center, Montreal, Quebec, Canada.
⁴ College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
⁵ Department of Epidemiology, Biostatistics, and Occupational Health, McGill University St. Mary's Research Center, Department of Epidemiology, Biostatistics, and Occupational Health, Montreal, Quebec, Canada.

Abstract

Purpose: Wide-awake local anesthesia hand surgery has many advantages over other forms of anesthesia, including faster recovery, lower cost, and improved patient safety; however, few studies compare postoperative pain and analgesic consumption after long- and short-acting anesthetics. This is important because surgeons seek to minimize opioid consumption during the opioid epidemic.

Methods: This was a double-blinded, prospective, randomized, parallel design pilot study. We randomized 61 patients to receive carpal tunnel surgery with a short-lasting regional anesthetic (lidocaine, 29 patients) or a long-lasting one (bupivacaine, 32 patients). Primary outcomes were pain levels over the first and second 24 hours. Secondary outcomes were postoperative consumption of acetaminophen and opioids over the first and second 12 hours after surgery.

Results: Pain intensity and acetaminophen consumption were significantly less in the bupivacaine group over the first 24 and 12 hours after surgery, respectively. The bupivacaine group consumed less opioids in the first 12 hours and delayed consumption of the first medication after surgery, but these results were not statistically significant. There was no difference in pain intensity or analgesic consumption between 24 and 48 hours after surgery.

Conclusions: The use of a long-term anesthetic (bupivacaine) over a short-term one (lidocaine) in awake carpal tunnel release surgery decreases postoperative pain over the initial 12 hours after surgery and delays the initiation of analgesic consumption; however, this difference is small. The amount of opioid consumption was not significantly different between groups, but both groups consumed less than 10% of the prescribed opioids. It is important to reevaluate the need for opioids in minor hand surgery and favor the use of alternatives such as nonsteroidal anti-inflammatory drugs and acetaminophen.

Type of study/level of evidence: Therapeutic I.

Keywords: awake hand surgery; local anesthesia; narcotic use; patient pain perception.