Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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The Onset and Duration of Action of 0.2% Lidocaine in a One-per-Mil Tumescent Solution for Hand Surgery

  • Prasetyono, Theddeus O.H. (Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital/Faculty of Medicine, University of Indonesia) ;
  • Lestari, Puri A. (Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital/Faculty of Medicine, University of Indonesia)
  • Received : 2015.06.25
  • Accepted : 2016.03.16
  • Published : 2016.05.18
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Abstract

Background One-per-mil tumescent solution, which contains 0.2% lidocaine with 1:1,000,000 epinephrine, has been reported to be clinically effective for hand surgery under local anesthesia. However, it was lacking in its basic pharmacokinetics profile in regard to the onset of action (OOA) and duration of action (DOA). Methods A randomized, double-blind study was conducted on 12 volunteers who met the inclusion criteria from October to November 2014. All volunteers had their right and left ring finger pulps injected with either one-per-mil solution or 2% lidocaine. Semmes-Weinstein and two-point discrimination tests were used to test sensation. Visual analogue scale was recorded at the time when the finger lost its sensation and when it regained normal sensation to measure the OOA and DOA. The data were then analyzed with a paired t-test and a Wilcoxon signed-rank test. Results The OOA and DOA of 2% plain lidocaine were 1 minute and 99.67 minutes, respectively. Meanwhile, 0.2% lidocaine in a one-per-mil tumescent solution showed an OOA of 5 minutes and a DOA of 186.83 minutes. The OOA of 0.2% lidocaine in a one-per-mil tumescent solution is statistically shorter than 2% plain lidocaine (P=0.04); while its DOA is statistically longer than 2% plain lidocaine (P<0.001). Conclusions The 0.2% lidocaine in a one-per-mil tumescent solution is statistically and clinically superior to 2% plain lidocaine in achieving longer duration of local anesthesia.

Keywords

References

  1. Tzeng YS, Chen SG. Tumescent technique in digits: a subcutaneous single-injection digital block. Am J Emerg Med 2012;30:592-6. https://doi.org/10.1016/j.ajem.2011.02.009
  2. 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; 118:429-32. https://doi.org/10.1097/01.prs.0000227632.43606.12
  3. McLure HA, Rubin AP. Review of local anaesthetic agents. Minerva Anestesiol 2005;71:59-74.
  4. Calder K, Chung B, O'Brien C, et al. Bupivacaine digital blocks: how long is the pain relief and temperature elevation? Plast Reconstr Surg 2013;131:1098-104. https://doi.org/10.1097/PRS.0b013e3182865dbb
  5. Rubin JP, Xie Z, Davidson C, et al. Rapid absorption of tumescent lidocaine above the clavicles: a prospective clinical study. Plast Reconstr Surg 2005;115:1744-51. https://doi.org/10.1097/01.PRS.0000161678.10555.53
  6. Prasetyono TO, Biben JA. One-per-mil tumescent technique for upper extremity surgeries: broadening the indication. J Hand Surg Am 2014;39:3-12.e7. https://doi.org/10.1016/j.jhsa.2013.09.034
  7. McKee DE, Lalonde DH, Thoma A, et al. Optimal time delay between epinephrine injection and incision to minimize bleeding. Plast Reconstr Surg 2013;131:811-4. https://doi.org/10.1097/PRS.0b013e3182818ced
  8. Keramidas EG, Rodopoulou SG. Ropivacaine versus lidocaine in digital nerve blocks: a prospective study. Plast Reconstr Surg 2007;119:2148-52. https://doi.org/10.1097/01.prs.0000260725.33655.88
  9. Denkler K. Dupuytren's fasciectomies in 60 consecutive digits using lidocaine with epinephrine and no tourniquet. Plast Reconstr Surg 2005;115:802-10. https://doi.org/10.1097/01.PRS.0000152420.64842.B6
  10. Higgins A, Lalonde DH, Bell M, et al. Avoiding flexor tendon repair rupture with intraoperative total active movement examination. Plast Reconstr Surg 2010;126:941-5. https://doi.org/10.1097/PRS.0b013e3181e60489
  11. Mann T, Hammert WC. Epinephrine and hand surgery. J Hand Surg Am 2012;37:1254-6. https://doi.org/10.1016/j.jhsa.2011.11.022
  12. Wilhelmi BJ, Blackwell SJ, Miller JH, et al. Do not use epinephrine in digital blocks: myth or truth? Plast Reconstr Surg 2001;107:393-7. https://doi.org/10.1097/00006534-200102000-00014
  13. Prasetyono TO. Tourniquet-Free Hand Surgery Using the One-per-Mil Tumescent Technique. Arch Plast Surg 2013; 40:129-33. https://doi.org/10.5999/aps.2013.40.2.129
  14. Prasetyono TO, Saputra DK, Astriana W. One-per-mil tumescent technique for bone and joint surgery in hand. Hand 2015;10:123-7. https://doi.org/10.1007/s11552-014-9661-7
  15. Lalonde DH. Wide-awake flexor tendon repair. Plast Reconstr Surg 2009;123:623-5. https://doi.org/10.1097/PRS.0b013e318195664c
  16. Lalonde DH. “Hole-in-one” local anesthesia for wide-awake carpal tunnel surgery. Plast Reconstr Surg 2010;126:1642-4. https://doi.org/10.1097/PRS.0b013e3181f1c0ef
  17. Bezuhly M, Sparkes GL, Higgins A, et al. Immediate thumb extension following extensor indicis proprius-to-extensor pollicis longus tendon transfer using the wide-awake approach. Plast Reconstr Surg 2007;119:1507-12. https://doi.org/10.1097/01.prs.0000256071.00235.d0
  18. Al Youha S, Lalonde DH. Update/Review: changing of use of local anesthesia in the hand. Plast Reconstr Surg Glob Open 2014;2:e150. https://doi.org/10.1097/GOX.0000000000000095
  19. Thomson CJ, Lalonde DH, Denkler KA, et al. A critical look at the evidence for and against elective epinephrine use in the finger. Plast Reconstr Surg 2007;119:260-6. https://doi.org/10.1097/01.prs.0000237039.71227.11
  20. Rubin JP, Bierman C, Rosow CE, et al. The tumescent technique: the effect of high tissue pressure and dilute epinephrine on absorption of lidocaine. Plast Reconstr Surg 1999; 103:990-6. https://doi.org/10.1097/00006534-199903000-00036
  21. Van der Spuy L. Complications of the arterial tourniquet. South Afr J Anaesth Anal 2012;18:14-8.
  22. Murphy CG, Winter DC, Bouchier-Hayes DJ. Tourniquet injuries: pathogenesis and modalities for attenuation. Acta Orthop Belg 2005;71:635-45.
  23. Vinycomb TI, Sahhar LJ. Comparison of local anesthetics for digital nerve blocks: a systematic review. J Hand Surg Am 2014;39:744-51.e5. https://doi.org/10.1016/j.jhsa.2014.01.017
  24. Oliveira PC, Volpato MC, Ramacciato JC, et al. Articaine and lignocaine efficiency in infiltration anaesthesia: a pilot study. Br Dent J 2004;197:45-6. https://doi.org/10.1038/sj.bdj.4811422
  25. Kakinoki R. Examination of the upper extremity. In: Neligan P, Chang J, editors. Plastic surgery. Volume six. London: Elsevier Saunders; 2013. p.47-67.

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