Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/37619
Title: Effect of Lidocaine 2% Versus Bupivacaine 0.5% and 1 Versus 2 Dual Separate Injections on Onset and Duration of Ultrasound-Guided Wrist Blocks: A Blinded 2 x 2 Factorial Randomized Clinical Trial
Authors: VAN BOXSTAEL, Sam 
Lopez, Ana M.
BALOCCO, Angela 
Vandepitte , Catherine
MEEX, Ingrid 
DUERINCKX, Joris 
Kuroda, Maxine M.
MESOTTEN, Dieter 
Van Herreweghe, Imre
Hadzic, Admir
Issue Date: 2022
Publisher: LIPPINCOTT WILLIAMS & WILKINS
Source: Anesthesia and analgesia, 134 (6) , p. 1318 -1325
Abstract: BACKGROUND: Local anesthetics are often selected or mixed to accomplish faster onset of anesthesia. However, with ultrasound guidance, local anesthetics are delivered with greater precision, which may shorten the onset time with all classes of local anesthetics. In this study, we compared onset time and duration of ultrasound-guided wrist blocks with a fast onset versus a longer lasting local anesthetic administered via single or dual (spatially separate) injections at the level of the midforearm. METHODS: In this randomized clinical trial, 36 subjects scheduled for carpal tunnel release were randomly assigned to receive ultrasound-guided median and ulnar nerve blocks with lidocaine 2% or bupivacaine 0.5% via single or dual injections (n = 9 in each group). Subjects fulfilled the study requirements. The main outcome variables were onset and duration of sensory blockade, which were tested separately in 2 (drug) x 2 (injection) analysis of variances (ANOVAs) with interaction terms. RESULTS: Sensory block onset time did not differ significantly between subjects given lidocaine 2% (9.2 +/- 3.4 minutes) or bupivacaine 0.5% (9.5 +/- 3.1 minutes) (P = .76; mean difference, -0.3 +/- 1.1 minutes [95% confidence interval {CI}, -2.5 to 1.9]) or between the single- (9.6 +/- 2.8 minutes) and dual- (9.1 +/- 3.6 minutes) injection groups (P = .69; mean difference, -0.4 +/- 1.1 minutes [95% CI, -1.8 to 2.6]). Sensory duration was longer for subjects in the bupivacaine 0.5% group (27.3 +/- 11.6 hours) than for subjects in the lidocaine 2% group (8.4 +/- 4.1 hours) (P < .001; 95% CI, 12.7-25.1). However, sensory duration in the single- (15.7 +/- 12.5 hours) and dual- (19.4 +/- 13.1 hours) injection groups did not differ significantly (P = .28; mean difference, -3.7 +/- 4.3 hours [95% CI, -12.6 to 5.1]). CONCLUSIONS: No significant effect was found for onset time between lidocaine 2% and bupivacaine 0.5% used in ultrasound-guided wrist blocks. Dual injections did not shorten onset time. Since mean nerve block duration was longer with bupivacaine 0.5%, our results suggest that the selection of local anesthetic for the median and ulnar nerves at the level of the midforearm should be based on the desired duration of the block and not on its speed of onset.
Notes: Van Boxstael, S (corresponding author), Ziekenhuis Oost Limburg, Dept Anesthesiol, Schiepse Bos 6, B-3600 Genk, Belgium.
sam.vanboxstael@zol.be
Keywords: Anesthetics, Local;Humans;Ultrasonography, Interventional;Wrist;Bupivacaine;Lidocaine
Document URI: http://hdl.handle.net/1942/37619
ISSN: 0003-2999
e-ISSN: 0003-2999
DOI: 10.1213/ANE.0000000000005936
ISI #: WOS:000798065000035
Rights: 2022 International Anesthesia Research Society
Category: A1
Type: Journal Contribution
Validations: ecoom 2023
Appears in Collections:Research publications

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