Reducing the Pain Associated with Local Anaesthetic Infiltration for open Carpal Tunnel Decompression

Abstract

This prospective, randomized study assessed the effectiveness of buffering lidocaine with sodium bicarbonate for reducing the pain associated with local anaesthetic infiltration for open carpal tunnel decompression. Twenty-one patients undergoing bilateral open carpal tunnel decompression received, in a randomized manner, lidocaine 1% with adrenaline (1:200,000) in one hand and the same local anaesthetic buffered with 8.4% NaHCO3 at a 5:1 ratio in the other hand. Pain, especially its burning element, was evaluated on a visual analogue scale and was significantly reduced with the buffered solution. The buffering was effective for all patients and no adverse effects were noted. This is a safe, easy and quick method for making open carpal tunnel surgery less uncomfortable to patients.

Local Anaesthesia for Carpal Tunnel Decompression: A Comparison of Two Techniques

“…The mean pain scores at this stage in the procedure were 3.2 and 3.3 with the modified Gale and the modified Altissimi and Mancini techniques, respectively. These were much lower than the pain scores described by Vossinakis et al (2004) with infiltration of unbuffered lignocaine. This could be because of the smaller volume of the anaesthetic used in our series (5 ml as compared to 15 ml in the study by Vossinakis et al, 2004).…”

“…These were much lower than the pain scores described by Vossinakis et al (2004) with infiltration of unbuffered lignocaine. This could be because of the smaller volume of the anaesthetic used in our series (5 ml as compared to 15 ml in the study by Vossinakis et al, 2004). We also injected the local anaesthetic slowly, which could also have contributed to this difference.…”

The Use of a Fine-Gauge Needle to Reduce Pain in Open Carpal Tunnel Decompression: A Randomized Controlled Trial

“…Three studies have looked at the effect of buffering acidic local anaesthetic solution to physiological pH prior to injection. Two showed some benefit (Vossinakis et al, 2004;Yiannakopoulos, 2004) and the third showed no pain reduction (Watts et al, 2004). Palmon et al (1998), in a study of healthy volunteers, randomized patients to injections with plain or buffered lidocaine using either a 25-gauge needle or a 30-gauge needle.…”

Optimal Solubility of Diclofenac β‐Cyclodextrin in Combination with Local Anaesthetics for Mesotherapy Applications

“…A reduction in pain at the site of injection, obtained through the addition of bicarbonate to lidocaine or mepivacaine, has been demonstrated in several clinical trials where local anaesthetics were given as cutaneous infiltration, including the treatment of traumatic wound lacerations [9], anaesthesia for digital nerve block [10], skin infiltration and intravenous catheterization prior to surgery [11], surgery for correction of prominent ears [12], repair surgery for combined upper eyelid blepharoplasty and levator advancement ptosis [13], carpal tunnel surgery [14, 15], and ambulatory phlebectomy procedures, the latter study testing specifically the association between mepivacaine and bicarbonate [16]. Overall, these studies were randomized controlled trials comparing a control group receiving the local anaesthetic given alone versus the group receiving the anaesthetic in a bicarbonate vehicle, and pain scores were obtained through visual analogic scales.…”