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How long to wait after local infiltration anaesthesia: systematic review
Mohammad Suleman Bajwa1,2, Muhammad Mustehsan Bashir1, Mohammad Hamza Bajwa3
1Department of Plastic & Reconstructive Surgery/Mayo Burn Centre, Mayo Hospital, King Edward Medical University, Lahore, Pakistan.
Optimal waiting times for lidocaine with epinephrine injections are clarified. Expect analgesia in 2 minutes, with vasoconstriction taking 7 minutes for eyelids and 25 minutes for other areas.
Area of Science:
- Anesthesiology and Pharmacology
- Surgical Techniques and Outcomes
Background:
- Conflicting evidence exists on optimal waiting times for local anesthetic effects.
- A systematic review is needed to establish evidence-based waiting strategies.
Approach:
- Systematic review of RCTs and prospective cohort studies.
- Primary outcomes: onset of analgesia and stable hypoperfusion.
- Methodological quality assessed using Cochrane risk-of-bias and Joanna Briggs Institute tools.
Key Points:
- Pooled mean for analgesia onset is 2.1 minutes, varying by site and nerve diameter.
- Stable hypoperfusion onset ranges from 7 minutes (eyelid) to 25 minutes (upper limb).
- Perfusion imaging studies show wide variability (0-30 minutes) due to technical differences.
Conclusions:
- Approximately 2 minutes are needed for complete analgesia.
- Optimal hypoperfusion requires waiting ~7 minutes for eyelids and ~25 minutes for other regions.
- Evidence-based waiting strategies can inform surgical decisions.
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