title: Comparison of bupivacaine and lidocaine with epinephrine for digital nerve blocks.
abstract: OBJECTIVE
  This study compared the efficacy in terms of pain of injection, time of onset and duration of action of digital blocks of bupivacaine 0.5% alone and lidocaine 1% with epinephrine (1:100,000).
  
  
  METHODS
  A randomised double-blind prospective study was performed in a single self-controlled group of 12 healthy volunteers (4 women, 8 men). Each participant was randomised to receive either lidocaine 1% with epinephrine (1:100,000) or bupivacaine 0.5% in either the right or left middle finger. Pain of injection was measured as the primary outcome using a 0-100 mm visual analogue scale. The time before anaesthesia to pinpricks was recorded and the duration of anaesthesia was reported by all volunteers. Statistical analysis was conducted using the non-parametric Wilcoxon signed rank test.
  
  
  RESULTS
  Median visual analogue scale scores were significantly different between the lidocaine + epinephrine and bupivacaine groups (26.00 mm (4-52) vs 40.50 mm (10-71), p<0.05). The median time before anaesthesia to pinpricks was not significantly different between the two drugs (3.45 min (3-8) vs 3.30 min (3-8), p = 0.84). The median time needed for return of pinpricks was significantly different between the two drugs (321 min (228-463) vs 701 min (245-913), p<0.05). Follow-up was completed at 24 h.
  
  
  CONCLUSIONS
  Lidocaine (1%) with epinephrine (1:100 000) was significantly less painful and had a shorter duration of action than bupivacaine (0.5%), which had a similar onset of action for digital nerve block.
  
  
  BACKGROUND
  ISRCTN45121950.
authors.affiliation: Department of Emergency Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. alhelail@yahoo.com
authors.forename: M
authors.initials: M
authors.lastname: Alhelail
authors.forename: M
authors.initials: M
authors.lastname: Al-Salamah
authors.forename: M
authors.initials: M
authors.lastname: Al-Mulhim
authors.forename: S
authors.initials: S
authors.lastname: Al-Hamid
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000009:adverse effects* / Q000494:pharmacology; D002045:Bupivacaine / Q000009:adverse effects* / Q000494:pharmacology; D004311:Double-Blind Method; D004338:Drug Combinations; D004837:Epinephrine / Q000009:adverse effects* / Q000494:pharmacology; D005260:Female; D005385:Fingers / Q000294:innervation; D006801:Humans; D008012:Lidocaine / Q000009:adverse effects* / Q000494:pharmacology; D008297:Male; D009407:Nerve Block / Q000009:adverse effects* / Q000379:methods; D010146:Pain / Q000139:chemically induced; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000494:pharmacology; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D004338:Drug Combinations; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D002045:Bupivacaine; D004837:Epinephrine