The effect of combining lidocaine and ropivacaine on the duration and onset time of an ultrasound-guided infraclavicular brachial plexus nerve block: A randomised controlled trial.
Sina Yousef, Mathias Therkel Steensbæk, Aurelien-Xuan Rosendal Bahuet, Rasmus Linnebjerg Knudsen, Cecilie Dupont Harwood, Charlotte Vallentin Rosenstock, Michelle Fog Andersen, Christian Rothe, Kai Henrik Wiborg Lange, Anders Kehlet Nørskov, Lars Hyldborg Lundstrøm
{"title":"The effect of combining lidocaine and ropivacaine on the duration and onset time of an ultrasound-guided infraclavicular brachial plexus nerve block: A randomised controlled trial.","authors":"Sina Yousef, Mathias Therkel Steensbæk, Aurelien-Xuan Rosendal Bahuet, Rasmus Linnebjerg Knudsen, Cecilie Dupont Harwood, Charlotte Vallentin Rosenstock, Michelle Fog Andersen, Christian Rothe, Kai Henrik Wiborg Lange, Anders Kehlet Nørskov, Lars Hyldborg Lundstrøm","doi":"10.1097/EJA.0000000000002261","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The combination of short- and long-acting local anaesthetics is traditionally associated with reduced block duration, though evidence remains inconsistent.</p><p><strong>Objectives: </strong>To investigate the effects of a fixed or reduced dose of a long-acting local anaesthetic (ropivacaine) mixed with a short-acting agent (lidocaine-epinephrine) on duration of analgesia and sensory onset time in lateral infraclavicular blocks.</p><p><strong>Design: </strong>Randomised, blinded, active-controlled superiority trial.</p><p><strong>Setting: </strong>A tertiary hospital in the Capital Region of Denmark, from 18 April to 23 November 2024.</p><p><strong>Patients: </strong>Seventy-eight patients undergoing hand surgery under lateral infraclavicular brachial plexus nerve block.</p><p><strong>Intervention: </strong>Patients were allocated to three groups: R150: 30 ml ropivacaine 5 mg ml -1 , R100-L200: 20 ml ropivacaine 5 mg ml -1 + 10 ml lidocaine-epinephrine 20 mg ml -1 + 5 μg ml -1 and R150-L200: 20 ml ropivacaine 7.5 mg ml -1 + 10 ml lidocaine-epinephrine 20 mg ml -1 + 5 μg ml -1 .</p><p><strong>Main outcome measures: </strong>The primary outcome was duration of analgesia, and secondary outcomes included sensory onset time.</p><p><strong>Results: </strong>The duration of analgesia was 847 (152) min in the R150 group, 536 (198) min in the R100-L200 group, and 671 (234) min in the R150-L200 group. Compared with that in the R150 group, the mean duration of analgesia was reduced by 311 min (95% confidence interval [CI], 212 to 411; P < 0.001) in the R100-L200 group and by 177 min (95% CI, 64 to 289; P = 0.003) in the R150-L200 group. The difference between the R100-L200 and R150-L200 groups was not statistically significant after adjustment for multiple testing (135 min; 95% CI, 13 to 257; P = 0.031). Sensory onset times ranged insignificantly from 17 to 18 min across groups.</p><p><strong>Conclusion: </strong>Mixing lidocaine-epinephrine with ropivacaine significantly shortened the duration of analgesia by up to 5 h without affecting the sensory onset time. This effect was independent of the ropivacaine dose.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov identifier: NCT06381622.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8000,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Anaesthesiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/EJA.0000000000002261","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The combination of short- and long-acting local anaesthetics is traditionally associated with reduced block duration, though evidence remains inconsistent.
Objectives: To investigate the effects of a fixed or reduced dose of a long-acting local anaesthetic (ropivacaine) mixed with a short-acting agent (lidocaine-epinephrine) on duration of analgesia and sensory onset time in lateral infraclavicular blocks.
Setting: A tertiary hospital in the Capital Region of Denmark, from 18 April to 23 November 2024.
Patients: Seventy-eight patients undergoing hand surgery under lateral infraclavicular brachial plexus nerve block.
Intervention: Patients were allocated to three groups: R150: 30 ml ropivacaine 5 mg ml -1 , R100-L200: 20 ml ropivacaine 5 mg ml -1 + 10 ml lidocaine-epinephrine 20 mg ml -1 + 5 μg ml -1 and R150-L200: 20 ml ropivacaine 7.5 mg ml -1 + 10 ml lidocaine-epinephrine 20 mg ml -1 + 5 μg ml -1 .
Main outcome measures: The primary outcome was duration of analgesia, and secondary outcomes included sensory onset time.
Results: The duration of analgesia was 847 (152) min in the R150 group, 536 (198) min in the R100-L200 group, and 671 (234) min in the R150-L200 group. Compared with that in the R150 group, the mean duration of analgesia was reduced by 311 min (95% confidence interval [CI], 212 to 411; P < 0.001) in the R100-L200 group and by 177 min (95% CI, 64 to 289; P = 0.003) in the R150-L200 group. The difference between the R100-L200 and R150-L200 groups was not statistically significant after adjustment for multiple testing (135 min; 95% CI, 13 to 257; P = 0.031). Sensory onset times ranged insignificantly from 17 to 18 min across groups.
Conclusion: Mixing lidocaine-epinephrine with ropivacaine significantly shortened the duration of analgesia by up to 5 h without affecting the sensory onset time. This effect was independent of the ropivacaine dose.
期刊介绍:
The European Journal of Anaesthesiology (EJA) publishes original work of high scientific quality in the field of anaesthesiology, pain, emergency medicine and intensive care. Preference is given to experimental work or clinical observation in man, and to laboratory work of clinical relevance. The journal also publishes commissioned reviews by an authority, editorials, invited commentaries, special articles, pro and con debates, and short reports (correspondences, case reports, short reports of clinical studies).