Alkalinisation of Local Anaesthetics Prescribed for Pain Relief after Surgical Decompression of Carpal Tunnel Syndrome

Özer, Hamza; Solak, Sukru; Oğuz, Temel; Öçgüder, Ali; Çolakoğlu, Tamer; Babacan, Avni

doi:10.1177/230949900501300312

Cited by 14 publications

(13 citation statements)

References 19 publications

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“…Ozer et al 10 studied the effects of alkalinization of local anesthetics during surgical decompression of the carpal tunnel. In this randomized controlled trial (RCT), 40 patients were assigned to receive either buffered local anesthetic (10 mL of prilocaine hydrochloride 2% buffered with 1 mL of bicarbonate 8.4%) or nonbuffered local anesthetic, with similar baseline characteristics.…”

Section: Resultsmentioning

confidence: 99%

“…It is of note to mention that most of the analyzed studies followed pain scores or analgesic consumption for a relatively short period postoperatively. Successful interventions included the use of buffered local anesthetic, 10 hyaluronidase, 11 and epinephrine during anesthetic administration. These interventions were proven to reduce postoperative pain and analgesic consumption in RCTs.…”

Section: Discussionmentioning

confidence: 99%

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Upper-Extremity Nerve Decompression Under Local Anesthesia: A Systematic Review of Methods for Reduction of Postoperative Pain and Opioid Consumption

Chocron

Aljerian

Thibaudeau

2019

Hand (New York, N,Y.)

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Background: Opioid abuse is a major health concern in North America. Data have shown an alarming increase in opioid-related deaths and complications, which has shed light on current prescription practices across many specialties, including hand surgery. To that end, we sought to conduct a focused literature review to determine the available modalities to decrease postoperative pain and opioid consumption following upper-extremity nerve decompression procedures, taking advantage of the homogeneity and inherent pain pathways of this specific patient cohort. Methods: A systematic review of the literature was conducted. Primary studies evaluating perioperative and intraoperative modalities for postoperative pain reduction and analgesic consumption following upper-extremity nerve decompression procedures under local anesthesia were included. Studies implementing modalities requiring non–hand surgeon expertise (ie, intravenous sedation), as well as studies that include non–nerve decompression procedures, were excluded. Results: A total of 1478 studies were identified, and 9 studies were included after full-text review. Six studies evaluated intraoperative and 3 studies evaluated preoperative and postoperative modalities. Successful interventions included buffered anesthetic, the use of hyaluronidase, and varying techniques and mixtures for anesthetic administration. No successful preoperative or postoperative modalities were identified. Conclusion: Despite data reporting on the dangers associated with current opioid prescription practices, evidence-based modalities to decrease postoperative pain and opioid consumption are limited in general. Several intraoperative modalities do exist, and nonopioid oral analgesics, standardized opioid protocols, and reduced postoperative prescriptions can be used. Large randomized controlled trials evaluating perioperative modalities for pain reduction are needed to further address this issue.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Upper-Extremity Nerve Decompression Under Local Anesthesia: A Systematic Review of Methods for Reduction of Postoperative Pain and Opioid Consumption

Chocron

Aljerian

Thibaudeau

2019

Hand (New York, N,Y.)

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“…Alkalinisation of local anesthetic solution has significantly low VAS score during first 12 h of postoperative period, change in VAS score is significantly higher for non-alkalinised local anesthetic solution [30]. Alkalinisation of local anesthetic solution produces less stinging pain during deposition of local anesthetic solution, injected solution is absorbed quickly by the normal tissue pH, increases the rate of diffusion and rapid onset of action.…”

Section: Discussionmentioning

confidence: 96%

A Comparative Study Between Bupivacaine with Adrenaline and Carbonated Bupivacaine with Adrenaline for Surgical Removal of Impacted Mandibular Third Molar

Shyamala¹,

Ramesh²,

Yuvaraj³

et al. 2015

J. Maxillofac. Oral Surg.

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Objectives To compare the effectiveness of bupivacaine with adrenaline with that of carbonated bupivacaine with adrenaline on pain, onset of anesthesia and duration of anesthesia following surgical removal of impacted mandibular third molar. Study design All the patients who underwent surgical removal of impacted mandibular third molar and who fulfilled our inclusion and exclusion criteria from 1st June 2013 to 30th June 2014 were included in our study. Patients who were diagnosed as having impacted mandibular third molar were randomly allocated to two groups namely group A (bupivacaine with adrenaline), group B (carbonated bupivacaine with adrenaline). Pain during deposition of local anesthetic, onset of anesthesia and duration of anesthesia were compared between the two groups. The collected data were subjected to statistical analysis by Chi Square test, Mann-Whitney U test. Results and conclusion The efficacy of carbonated bupivacaine with adrenaline is more compared with bupivacaine with adrenaline in decreasing pain on deposition of local anesthetic solution and in rapid onset of anesthesia. The duration of anesthesia for carbonated bupivacaine with adrenaline and bupivacaine with adrenaline had no significant difference. The use of carbonated bupivacaine with adrenaline will reduce the patient discomfort both intraoperatively and post-operatively.

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“…The basic non-ionized local anesthesia has a higher ability to diffuse across the membrane of the nerve. It results in the early onset of anesthesia and reduced pain during the injection [10,15]. Moreover, carbon dioxide is also produced by sodium bicarbonate [16].…”

Section: Discussionmentioning

confidence: 99%

“…The potency, duration of action, and the onset of anesthesia of a local anesthetic are influenced by its structure, concentration, pKa (acid dissociation constant), and tissue pH [10]. The aim of this prospective, randomized, double-blind research was to see if adding sodium bicarbonate to a local anesthetic solution affected injection pain, duration, and efficacy.…”

Section: Introductionmentioning

confidence: 99%

Effect of Buffered Local Anesthesia on Perioperative Pain During Arteriovenous Fistula Surgery: A Randomized Control Trial

Arif¹,

Riaz²,

Bhatti³

et al. 2021

Cureus

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Objective: This prospective, pilot randomized double-blind study aimed to compare the effects of buffered and non-buffered xylocaine solutions on injection pain and anesthesia effectiveness in patients undergoing arteriovenous fistula surgery.Material and methods: A total of 100 adult patients meeting inclusion criteria undergoing arteriovenous fistula surgery were included in the study. They were split into two groups at random. The control group received 1% xylocaine dissolved in 5 ml distilled water, while the intervention group received sodium bicarbonate mixed with 1% xylocaine solution as a local anesthetic. The patients were asked to rate the pain of first and subsequent injections on a visual analog scale (VAS). Besides, the need for extra analgesia was investigated. The mean and standard deviation of the data was determined.Results: During both the first and subsequent injections, the alkalinized local anesthetic group showed substantially lower VAS scores. In the alkalinized local anesthetic group, anesthesia satisfaction was also more than three times higher. Furthermore, the non-alkalinized group's mean analgesic requirement was higher than the intervention group. Conclusion:Our findings support the effectiveness of the alkalinized local anesthetic solution in minimizing injection pain and increasing anesthesia duration and overall patient's surgical experience in terms of anesthesia satisfaction score.

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Alkalinisation of Local Anaesthetics Prescribed for Pain Relief after Surgical Decompression of Carpal Tunnel Syndrome

Abstract: Buffered prilocaine provided a longer postoperative pain-free period for patients undergoing surgical decompression of the median nerve. It is easy, safe, and cost-effective.

Cited by 14 publications

References 19 publications

Upper-Extremity Nerve Decompression Under Local Anesthesia: A Systematic Review of Methods for Reduction of Postoperative Pain and Opioid Consumption

Upper-Extremity Nerve Decompression Under Local Anesthesia: A Systematic Review of Methods for Reduction of Postoperative Pain and Opioid Consumption

A Comparative Study Between Bupivacaine with Adrenaline and Carbonated Bupivacaine with Adrenaline for Surgical Removal of Impacted Mandibular Third Molar

Effect of Buffered Local Anesthesia on Perioperative Pain During Arteriovenous Fistula Surgery: A Randomized Control Trial

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