BUPIVACAINE VERSUS LIDOCAINE LOCAL ANESTHESIA FOR OPEN CARPAL TUNNEL RELEASE: A RANDOMIZED COMPARATIVE STUDY



Areewan M S Saeed a



Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq. 
 
 
Submitted: 24/2/2019; Accepted: 18/6/2019; Published: 21/6/2019

ABSTRACT


Background 

Carpal tunnel syndrome is symptomatic compression of the median nerve at the wrist; surgery can be performed under general and local anesthesia. Local anesthesia is associated with shorter operative time and fewer coasts.


Objectives

To compare the use of Bupivacaine and Lidocaine when performing open carpal tunnel surgery.


Patients and Methods

We studied the visual analogue scale, intraoperative blood loss and postoperative intake of analgesics in 85 patients (100 wrists), whom divided randomly to two groups, each receiving one type of local anesthesia. Age range 20-80years, female 84 and one male, 61 patients having moderate and 24 having severe grades.


Results

The mean visual analogue score was significantly less in the first group the first10 hours, 7 days and 14 days postoperatively (p values 0.001, 0.001, 0.02), thereafter the mean difference was not significant (P value 0.06-0.11). Intra operative bleeding was significantly less in the bupivacaine group (66% ≤ 6 ml) when compared to the Lidocaine group, (92% ≥6ml and 59% having loss of 10 ml). The difference in consumption of acetaminophen in the first two weeks was statistically significant. In the first group 39 patients (76.4%) taking <15 grams, while in the second group 36 patients (73.4%) taking >15 grams.


Conclusion

Bupivacaine provides longer postoperative pain relief, less chance of long standing pain and significantly less intraoperative bleeding. The need for postoperative analgesia is significantly less making the procedure relatively safe and less coasty when using bupivacaine.



KEYWORDS

Carpal tunnel syndrome, Open surgery, Local anesthesia, Bupivacaine, Lidocaine.