Mixture of Lidocaine and Ropivacaine as a Local Anesthetic in WALANT Surgery: A Prospective Randomized Study.

Purpose: With lidocaine, the wide awake local anesthesia no tourniquet (WALANT) technique provides effective anesthesia. However, analgesia is also short with this technique (3 hours). This study analyzed pain relief and quality of recovery when ropivacaine (a long-acting local anesthetic, 8-12 hours) was added to lidocaine.

Methods: This prospective, double-blinded randomized study included patients scheduled for distal upper limb surgery under WALANT. Patients were randomly assigned to a group: the lidocaine group (20 mL of 1% lidocaine at 1:100,000 epinephrine) or the lidocaine-ropivacaine group (18 mL of 1% lidocaine at 1:100,000 epinephrine and 2 mL of 0.75% ropivacaine). The primary end point was the postoperative Quality of Recovery (QoR)-40 score at Day 2. Secondary end points were the pain score for the first 7 days postsurgery, rescue analgesia, adverse medical and surgical events, and chronic pain at 3 months.

Results: Over the study period, 91 patients were randomized. The QoR score was 187 (182-190) in the lidocaine group and 186 (180-188) for lidocaine-ropivacaine group. The median duration of analgesia was 8 (4-12) hours for the lidocaine group and 8 (4-10) hours for the lidocaine-ropivacaine group. No difference was observed between groups regarding rescue analgesia, pain score, adverse events, or incidence of chronic pain at 3 months.

Conclusions: Adding ropivacaine to lidocaine for WALANT did not improve patient recovery after surgery.

Type of study/level of evidence: Therapeutic Ib.