For minor hand surgery, the combination of a tourniquet and buffered lidocaine solution works best, according to a new study.
Tourniquet With Lidocaine Better Anesthetic for Minor Hand Surgery
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Secondary#anesthesia#minorhandsurgery#tourniquet
The study, “A randomized controlled trial of three different local anesthetic methods for minor hand surgery,” was published on January 6, 2022, in the Journal of Orthopaedic Surgery.
“Hemostasis and local anesthetic injection are essential for minor hand surgeries under local anesthesia. Wide awake local anesthesia no tourniquet became popular for achieving hemostasis without a tourniquet. However, a recent study reported that injection is more painful than tourniquet use in minor hand surgery,” the study authors wrote.
Because of this, they sought to compare three local anesthesia methods that differ according to injection and hemostasis: the combination of a tourniquet and buffered lidocaine solution, wide awake local anesthesia no tourniquet, and conventional local anesthesia.
The study included 169 patients who underwent minor hand surgery between 2017 and 2020. They were randomly assigned to one of the three anesthesia methods. During the surgery, the researchers recorded all pain and anxiety scores as well as satisfaction after surgery.
They report that pure lidocaine injection was more painful than buffered lidocaine and wide awake local anesthesia no tourniquet solution injection (p < 0.001). In addition, local anesthesia injection was more painful than tourniquet use in all groups (p < 0.001).
The researchers also found that the intraoperative anxiety score was lower in the combination of a tourniquet and buffered lidocaine solution group than in the conventional local anesthesia and wide awake local anesthesia no tourniquet groups (p < 0.001).
The satisfaction score was also higher in the combination of a tourniquet and buffered lidocaine solution and wide awake than local anesthesia no tourniquet and conventional local anesthesia.
“Combination of a tourniquet and buffered lidocaine solution for minor hand surgery under local anesthesia is associated with less injection pain and patient anxiety. The tourniquet is tolerable without much pain and waiting time. Thus, combination of a tourniquet and buffered lidocaine solution is a good alternative to wide awake local anesthesia with no tourniquet and conventional local anesthesia,” the researchers wrote.
The study authors included Sang Ki Lee, Woo-suk Kim and Won Sik Choy of Eulji University College of Medicine, Daejeon, Korea.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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