The use of local anesthetics has become an important aspect of pain management in surgical
settings and is currently recommended in pain management guidelines.
Elective outpatient hand surgeries, such as carpal tunnel or trigger finger release, cause
minimum tissue disruption and are short in duration. As a result, these local anesthetic
agents are a major component in post-operative pain control. The most commonly used local
anesthetic agents are Lidocaine and Bupivacaine. Lidocaine acts faster (within 2-5 minutes of
injection) and for this reason is often favored in outpatient setting for pre-incisional
injection. However its effects only last up to 2 hours, without epinephrine, and 3 hours,
with epinephrine. On the other hand, Bupivacaine, has a slower onset of action (about 5-10
minutes after injection) but its effects last much longer, for about 4-8 hours. The delay in
onset of action makes it a less popular option as a primary source of local anesthesia in
outpatient hand surgery.
Given the longer duration of anesthesia offered by Bupivacaine, the investigators believe
that by giving it pre-operatively in elective outpatient hand surgeries will offer more
effective post operative pain control compared to using Lidocaine only. There is limited
published data confirming the effectiveness of use of pre-operative Bupivicaine in improved
postoperative pain control and decreased consumption of narcotics. Therefore, the aim in this
study is to compare the postoperative pain experienced by patients undergoing either elective
carpal tunnel release or trigger finger release as well as their use of pain medications when
the incision site is infiltrated preemptively with Lidocaine versus Bupivacaine.
The investigators believe that adequate post surgical pain control is essential for patients'
full functional recovery. Poorly controlled post surgical pain increases incidence of surgery
related complications and thus increased health care costs. It can also reduce patients'
mobility, delay their return to full function,. If poorly controlled, post surgical pain may
progress to chronic pain and rarely complex regional pain syndromes may ensue.
Phase:
Phase 4
Details
Lead Sponsor:
University of British Columbia
Treatments:
Anesthetics Anesthetics, Local Bupivacaine Lidocaine