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Comparison of bupivacaine and lidocaine with epinephrine for digital nerve blocks
  1. M Alhelail1,
  2. M Al-Salamah2,
  3. M Al-Mulhim1,
  4. S Al-Hamid2
  1. 1
    Department of Emergency Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
  2. 2
    Emergency Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
  1. Dr M Alhelail, P O Box 230691, Riyadh 11321, Saudi Arabia; alhelail{at}


Objective: This study compared the efficacy in terms of pain of injection, time of onset and duration of action of digital blocks of bupivacaine 0.5% alone and lidocaine 1% with epinephrine (1:100 000).

Methods: A randomised double-blind prospective study was performed in a single self-controlled group of 12 healthy volunteers (4 women, 8 men). Each participant was randomised to receive either lidocaine 1% with epinephrine (1:100 000) or bupivacaine 0.5% in either the right or left middle finger. Pain of injection was measured as the primary outcome using a 0–100 mm visual analogue scale. The time before anaesthesia to pinpricks was recorded and the duration of anaesthesia was reported by all volunteers. Statistical analysis was conducted using the non-parametric Wilcoxon signed rank test.

Results: Median visual analogue scale scores were significantly different between the lidocaine + epinephrine and bupivacaine groups (26.00 mm (4–52) vs 40.50 mm (10–71), p<0.05). The median time before anaesthesia to pinpricks was not significantly different between the two drugs (3.45 min (3–8) vs 3.30 min (3–8), p = 0.84). The median time needed for return of pinpricks was significantly different between the two drugs (321 min (228–463) vs 701 min (245–913), p<0.05). Follow-up was completed at 24 h.

Conclusion: Lidocaine (1%) with epinephrine (1:100 000) was significantly less painful and had a shorter duration of action than bupivacaine (0.5%), which had a similar onset of action for digital nerve block.

Trial registration number: ISRCTN45121950

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  • Competing interests: None.

  • Funding: None.

  • Ethics approval: The study was approved by the hospital Research Advisory Council after being reviewed and approved by both the Clinical Research and Research Ethics Committees. All volunteers signed a written consent form on the day of the procedure.

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