Are There Differences in Postoperative Pain Between Bupivacaine and Lidocaine for Carpal Tunnel Release?

Summary

The goal of this clinical trial is to compare the use of bupivacaine and lidocaine as local anesthetics in carpal tunnel release surgery. The main questions it aims to answer are: * Are there any differences in pain after surgery? * Are there any differences in postoperative analgesic consumption?

Timeline

Start

2022-09-13

Primary completion

2023-08-07

Completion

2023-08-26

Outcome

Missed primary endpoint

paper The addition of bupivacaine to the standard WALANT solution did not modify PO pain intensity after CTR. PMID 42100467 ↗

paper Pain trajectories, total analgesic consumption, timing of first analgesic intake, and sleep disruption demonstrated no clinically meaningful differences. PMID 42100467 ↗

Publications

• Background Lalonde D, Martin A. Epinephrine in local anesthesia in finger and hand surgery: the case for wide-awake anesthesia. J Am Acad Orthop Surg. 2013 Aug;21(8):443-7. doi: 10.5435/JAAOS-21-08-443.
• Background Lalonde DH. "Hole-in-one" local anesthesia for wide-awake carpal tunnel surgery. Plast Reconstr Surg. 2010 Nov;126(5):1642-1644. doi: 10.1097/PRS.0b013e3181f1c0ef. No abstract available.
• Background Lalonde D. Minimally invasive anesthesia in wide awake hand surgery. Hand Clin. 2014 Feb;30(1):1-6. doi: 10.1016/j.hcl.2013.08.015. Epub 2013 Nov 9.
• Background Chan ZH, Balakrishnan V, McDonald A. Short versus long-acting local anaesthetic in open carpal tunnel release: which provides better preemptive analgesia in the first 24 hours? Hand Surg. 2013;18(1):45-7. doi: 10.1142/S0218810413500081.
• Background Diaz-Abele J, Luc M, Dyachenko A, Aldekhayel S, Ciampi A, McCusker J. Lidocaine With Epinephrine Versus Bupivacaine With Epinephrine as Local Anesthetic Agents in Wide-Awake Hand Surgery: A Pilot Outcome Study of Patient's Pain Perception. J Hand Surg Glob Online. 2019 Oct 31;2(1):1-6. doi: 10.1016/j.jhsg.2019.09.004. eCollection 2020 Jan.
• Rellan I, De Carli P, Bronenberg Victorica P, Holc F, Donndorff AG, Martinez EF, Abrego MO, Gallucci G, Boretto JG. Does addition of a bupivacaine improve postoperative pain after carpal tunnel release in WALANT? A prospective randomized trial. J Hand Microsurg. 2026 Apr 27;18(4):100467. doi: 10.1016/j.jham.2026.100467. eCollection 2026 Jul.

Drugs

Evaluation	Drug	Modality	Dose	Route
Subject	Bupivacaine	Other / unclassified	0.5 %	Subcutaneous
Subject	Bupivacaine	Other / unclassified	1 %	Subcutaneous
Subject	Bupivacaine	Other / unclassified	10 ml	Subcutaneous
Subject	Lidocaine	Other / unclassified	1 %	Subcutaneous
Subject	Lidocaine	Other / unclassified	10 ml	Subcutaneous
Subject	Lidocaine	Other / unclassified	20 ml	Subcutaneous

Indications