Bupivacaine Versus Lidocaine Local Anesthesia
Condition: Carpal Tunnel Syndrome; Trigger Finger
MeSH terms: Trigger Finger Disorder; Carpal Tunnel Syndrome
Study type: Interventional
Phase: Phase 4

Summary: 
      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.
    

Detailed description: 
      Subjects will be randomized to receive either 10ml of 0.5% Bupivacaine with 1:200,000
      Epinephrine or 10 ml of 1% Lidocaine with 1:100,000 Epinephrine.

      In the case of a single digit surgery such as the trigger finger release, the dose will be
      adjusted to 5ml of 0.5% Bupivacaine with 1:200,000 Epinephrine or 5ml of 1% Lidocaine with
      1:100,000 Epinephrine.

      An additional 5ml of study drug will be prepared in a separate syringe and administered when
      needed.
    

Intervention name(s): Bupivacaine; Lidocaine
Intervention type(s): Drug; Drug
Intervention description(s): Local anesthetics; Local anesthetics
Intervention MeSH terms: Lidocaine; Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Treatment
Keywords: Local anesthetics; Elective hand surgeries