Muhammad Mustehsan Bashir1, Rehan Qayyum2, Muhammad Hammad Saleem3, Kashif Siddique4, Farid Ahmad Khan3. 1. Plastic Surgery Department, King Edward Medical University, Mayo Hospital Lahore, Lahore, Punjab, Pakistan. Electronic address: mmb166@yahoo.com. 2. Department of Medicine, University of Tennessee College of Medicine at Chattanooga, Chattanooga, TN. 3. Plastic Surgery Department, King Edward Medical University, Mayo Hospital Lahore, Lahore, Punjab, Pakistan. 4. Department of Biostatistics, King Edward Medical University, Mayo Hospital Lahore, Lahore, Punjab, Pakistan.
Abstract
PURPOSE: To determine the optimal time interval between tumescent local anesthesia infiltration and the start of hand surgery without a tourniquet for improved operative field visibility. METHODS:Patients aged 16 to 60 years who needed contracture release and tendon repair in the hand were enrolled from the outpatient clinic. Patients were randomized to 10-, 15-, or 25-minute intervals between tumescent anesthetic solution infiltration (0.18% lidocaine and 1:221,000 epinephrine) and the start of surgery. The end point of tumescence anesthetic infiltration was pale and firm skin. The surgical team was blinded to the time of anesthetic infiltration. At the completion of the procedure, the surgeon and the first assistant rated the operative field visibility as excellent, fair, or poor. We used logistic regression models without and with adjustment for confounding variables. RESULTS: Of the 75 patients enrolled in the study, 59 (79%) were males, 7 were randomized to 10-minute time intervals (further randomization was stopped after interim analysis found consistently poor operative field visibility), and 34 were randomized to the each of the 15- and 25-minute groups. Patients who were randomized to the 25-minute delay group had 29 times higher odds of having an excellent operative visual field than those randomized to the 15-minute delay group. After adjusting for age, sex, amount of tumescent solution infiltration, and duration of operation, the odds ratio remained highly significant. CONCLUSIONS: We found that an interval of 25 minutes provides vastly superior operative field visibility; 10-minute delay had the poorest results. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
RCT Entities:
PURPOSE: To determine the optimal time interval between tumescent local anesthesia infiltration and the start of hand surgery without a tourniquet for improved operative field visibility. METHODS:Patients aged 16 to 60 years who needed contracture release and tendon repair in the hand were enrolled from the outpatient clinic. Patients were randomized to 10-, 15-, or 25-minute intervals between tumescent anesthetic solution infiltration (0.18% lidocaine and 1:221,000 epinephrine) and the start of surgery. The end point of tumescence anesthetic infiltration was pale and firm skin. The surgical team was blinded to the time of anesthetic infiltration. At the completion of the procedure, the surgeon and the first assistant rated the operative field visibility as excellent, fair, or poor. We used logistic regression models without and with adjustment for confounding variables. RESULTS: Of the 75 patients enrolled in the study, 59 (79%) were males, 7 were randomized to 10-minute time intervals (further randomization was stopped after interim analysis found consistently poor operative field visibility), and 34 were randomized to the each of the 15- and 25-minute groups. Patients who were randomized to the 25-minute delay group had 29 times higher odds of having an excellent operative visual field than those randomized to the 15-minute delay group. After adjusting for age, sex, amount of tumescent solution infiltration, and duration of operation, the odds ratio remained highly significant. CONCLUSIONS: We found that an interval of 25 minutes provides vastly superior operative field visibility; 10-minute delay had the poorest results. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.