Wide Awake Trigger Finger Release Surgery: Prospective Comparison of Lidocaine, Marcaine, and Exparel

Abstract

Background: Local anesthetics are routinely used in hand surgery for procedures such as trigger finger releases (TFRs). However, little is known as to the difference in efficacy and patient experience with various local anesthetics. We prospectively evaluated the efficacy of Lidocaine (L), Marcaine (M), and Exparel (E) to elucidate differences in pain scores and opioid consumption between these groups.

Methods: All consecutive TFR performed over a 6-month period in 2014 at our institution were divided to receive Lidocaine, Marcaine, or Marcaine with postoperative Exparel. Pain levels, daily opioid consumption, and adverse reactions were recorded and analyzed for postoperative day (POD) 0-3.

Results: A total of 154 patients were enrolled (L:53, M:50, E:51). The Lidocaine group reported the highest pain levels for POD 0-1. Marcaine pain levels were similar to Exparel on POD 0 but higher on POD 1. Opioid consumption on POD 0-1 was significantly different with E:27%, M:58% and L:59% as was the number of pills consumed (E:0.70, M: 1.08 and L:1.62). In addition, 50% of Exparel patients required no pain medications and experienced significantly less adverse reactions (E:4%, M:10%, L:13%). By POD 2-3, there were no statistical differences between the 3 groups.

Conclusions: Patients treated with Marcaine attain better pain control than Lidocaine on POD 0-1but only patients who received Exparel maintained the lowest pain levels through POD 0-3 while using little-to-no opioid medications and with less adverse reactions than Lidocaine or Marcaine alone.

Keywords: Exparel; Lidocaine; Marcaine; trigger finger; wide awake.

Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.

Patient reported pain as a VAS score during the first 3 days postoperatively for each of the anesthetic agents administered. Note. VAS, visual analog scale.

Figure 2.

(a) Percentage of patients in each anesthetic group that required opioid medications during the first 3 days after surgery. (b) Average number of pills consumed by the subset of patients requiring opioid medications during the postoperative period.

Figure 3.

(a) Percentage of patients in each anesthetic group that required no medications (opioid or otherwise) during the first 3 days after surgery. (b) Percentage of patients who report being pain-free (VAS score Note. VAS, visual analog scale.

Figure 4.

Patient reported percentage of adverse reactions based on the anesthetic group. Note. AE, adverse event.