title: Bupivacaine digital blocks: how long is the pain relief and temperature elevation?
abstract: BACKGROUND
  The goals of this study are threefold: (1) to determine what effect epinephrine has on the duration of bupivacaine finger block anesthesia; (2) to see whether the duration of action of bupivacaine on digital pain relief is the same duration as numbness to touch/pressure; and (3) to assess the fingertip temperature changes that result from bupivacaine digital blocks.
  
  
  METHODS
  The ring fingers of both hands of 44 volunteers were randomized to injection of bupivacaine with or without 1:200,000 epinephrine. The durations of time for digits to return to normal pain, touch, pressure sensation, and fingertip temperature were measured and recorded.
  
  
  RESULTS
  There were three main findings: (1) the pain block of bupivacaine lasts only half as long (15 hours) as the return to normal sensation (30 hours); (2) the effect of adding epinephrine to bupivacaine prolongs the duration of pain relief in a finger block for only an additional 1.5 hours; (3) in addition to pain relief, bupivacaine finger blocks cause fingertip hyperemia with consistent significant fingertip temperature elevation that lasts 15 hours.
  
  
  CONCLUSIONS
  The duration of bupivacaine pain relief is the clinically important factor that needs to be reported in bupivacaine trials. Patients should be informed that the return of pain will occur much sooner than the return of normal sensation. Adding epinephrine to bupivacaine does not add a clinically significant length of time to pain relief. Bupivacaine finger blocks provide prolonged hyperemia and pain block to fingertips, which may be useful in the treatment of acute frostbite.
  
  
  METHODS
  Therapeutic, I.
authors: Halifax, Nova Scotia, Canada From the Division of Plastic Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax Infirmary.
authors: Kevin
authors: K
authors: Calder
authors: Bryan
authors: B
authors: Chung
authors: Cliona
authors: C
authors: O'Brien
authors: Donald H
authors: DH
authors: Lalonde
mesh_terms: D059787:Acute Pain / Q000188:drug therapy*; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D001831:Body Temperature / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005385:Fingers / Q000294:innervation; D006801:Humans; D006940:Hyperemia / Q000139:chemically induced; D006987:Hypesthesia / Q000139:chemically induced; D008297:Male; D009407:Nerve Block / Q000379:methods*; D011312:Pressure; D012881:Skin Temperature / Q000187:drug effects*; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis*; D013997:Time Factors; D055698:Touch Perception / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D002045:Bupivacaine; D004837:Epinephrine
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