Does addition of a bupivacaine improve postoperative pain after carpal tunnel release in WALANT? A prospective...

To compare the intensity and duration of pain during the first and second 24-h postoperative (PO) periods following carpal tunnel release (CTR). Secondary objectives were to compare the total number of analgesic tablets consumed, the time to first analgesic intake, and the degree of sleep disruption and nocturnal pain intensity during the first PO night.

We conducted a prospective, randomized, controlled trial of patients undergoing CTR with WALANT. Participants were randomly assigned to:10 mL of 1% lidocaine with epinephrine combined with 10 mL of 0.5% bupivacaine hydrochloride, or 20 mL of 1% lidocaine with epinephrine. All patients received a standardized, self-administered questionnaire designed to document pain intensity, the timing and amount of analgesic consumption, and subjective sleep quality during the first 48 PO hours. Pain intensity was recorded using a numerical rating scale, and analgesic use was documented in detail.

Eighty-two patients were included. Mean PO pain scores were similar between groups across both 24-h periods. On PO day one, mean scores were 0.6 (SD 1.73; range 0-7) in the bupivacaine group and 0.6 (SD 1.65; range 0-6) in the lidocaine group. On PO day two, scores decreased to 0.06 (SD 0.20) and 0.02 (SD 0.28), respectively. The bupivacaine group experienced a delayed onset of peak pain by 4 h and a longer pain-free interval before requiring the first analgesic intake.Pain trajectories, total analgesic consumption, timing of first analgesic intake, and sleep disruption demonstrated no clinically meaningful differences.

The addition of bupivacaine to the standard WALANT solution did not modify PO pain intensity after CTR. Total analgesic use, timing to first intake, and sleep disruption were also comparable between groups.

NCT05697276 https://clinicaltrials.gov/study/NCT05697276?lat=-34.6062243&lng=-58.42563990000001&locStr=Hospital%20Italiano%20de%20Buenos%20Aires,%20Teniente%20General%20Juan%20Domingo%20Perón,%20Buenos%20Aires,%20Argentina&distance=50&term=WALANT&rank=2.

Therapeutic Ib.