title: Effect of Time Interval Between Tumescent Local Anesthesia Infiltration and Start of Surgery on Operative Field Visibility in Hand Surgery Without Tourniquet.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Therapeutic I.
authors.affiliation: Plastic Surgery Department, King Edward Medical University, Mayo Hospital Lahore, Lahore, Punjab, Pakistan. Electronic address: mmb166@yahoo.com.
authors.forename: Muhammad Mustehsan
authors.initials: MM
authors.lastname: Bashir
authors.affiliation: Department of Medicine, University of Tennessee College of Medicine at Chattanooga, Chattanooga, TN.
authors.forename: Rehan
authors.initials: R
authors.lastname: Qayyum
authors.affiliation: Plastic Surgery Department, King Edward Medical University, Mayo Hospital Lahore, Lahore, Punjab, Pakistan.
authors.forename: Muhammad Hammad
authors.initials: MH
authors.lastname: Saleem
authors.affiliation: Department of Biostatistics, King Edward Medical University, Mayo Hospital Lahore, Lahore, Punjab, Pakistan.
authors.forename: Kashif
authors.initials: K
authors.lastname: Siddique
authors.affiliation: Plastic Surgery Department, King Edward Medical University, Mayo Hospital Lahore, Lahore, Punjab, Pakistan.
authors.forename: Farid Ahmad
authors.initials: FA
authors.lastname: Khan
mesh_terms: D000293:Adolescent; D000328:Adult; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002056:Burns / Q000150:complications; D003286:Contracture / Q000209:etiology / Q000601:surgery*; D004334:Drug Administration Schedule; D005260:Female; D050823:Hand Joints; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D014111:Tourniquets; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine
keywords: Tumescent local anesthesia; hand surgery without tourniquet; operative field visibility