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Bupivacaine Digital Blocks: How Long is the Pain Relief and Temperature Elevation?

This study has been completed.
Information provided by (Responsible Party):
Lalonde, Donald H., M.D. Identifier:
First received: October 1, 2012
Last updated: October 2, 2012
Last verified: October 2012

No one knows how long bupivacaine finger blocks last. Many use bupivacaine with and without epinephrine, but no one knows how the epinephrine affects the duration of the block. We also don't know how long the pain part of the block lasts, which is what counts.

The goal of the study is to determine the duration of action of bupivacaine digital nerve blocks (with and without epinephrine) on finger temperature and the sensory modalities of pain, touch, and pressure. 2 ml of bupivacaine 0.5% with and without epinephrine will be injected at the base of each ring finger on the palm surface. At the end of 1 hr, 6 hrs, 12 hrs, 14 hrs and each additional hour, patients will use an insulin lancet to measure pain, the Semmes Weinstein monofilament test to measure light touch and pressure and a body surface thermometer to measure finger temperature. The time for the finger to return to normal sensation and temperature will be measured.

Condition Intervention
Pain Drug: Bupivacaine 0.5% Drug: Bupivacaine 0.5% + Epinephrine (1:200,000)

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary Purpose: Treatment
Official Title: Bupivacaine Digital Blocks: How Long is the Pain Relief and Temperature Elevation?

Resource links provided by NLM:

Further study details as provided by Lalonde, Donald H., M.D.:

Primary Outcome Measures:
  • Time to return of pin-prick (pain) sensation [ Time Frame: 24 hours ]

Enrollment: 44
Study Start Date: July 2009
Study Completion Date: July 2010
Primary Completion Date: July 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Ring Finger Nerve Block Drug: Bupivacaine 0.5% Drug: Bupivacaine 0.5% + Epinephrine (1:200,000)

Detailed Description:

Lidocaine finger blocks have been shown to provide analgesia for nearly 5 hours without epinephrine and approximately 10 hours with epinephrine - essentially doubling its duration.1,2 The analgesic effect of epinephrine on the duration of bupivacaine finger blocks remains unknown.

Bupivacaine finger injection provides a much longer duration of action than lidocaine. Previous studies have shown the duration of action to be as long as 24.9 hours.1 In the senior author's experience, however, patients who get bupivacaine blocks start asking for pain medication as early as 7 hours after the block. Is it possible that the pain blocking effect of bupivacaine has a different duration than the touch and pressure effects? The answer to this question also remains unknown.

The third unknown question about bupivacaine digital blocks is their effect on fingertip temperature. It has been shown that lidocaine wrist blocks increase temperature in finger tips, and this has been postulated to be potentially helpful in frostbite to provide pain relief and hyperemia.3 Previous studies have shown bupivacaine to exhibit vasodilatory properties at clinical concentrations of injection.4-7 Does bupivacaine provide increased warmth to the finger tip? How long does it last?

The goals of this study are three fold: 1.) To determine what effect epinephrine has on the duration of bupivacaine finger block anesthesia. 2.) To assess the duration of action of bupivacaine with and without epinephrine on the digital sensory modalities of pain, touch and pressure, and 3.) To assess the finger tip temperature changes that result from bupivacaine digital blocks with and without epinephrine.


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  • Healthy adult volunteer

Exclusion Criteria:

  • Under the age of majority
  • Unable to give consent
  • Pregnancy
  • Diabetes
  • Allergy to local anesthetic
  • Prior finger surgery
  • Preexisting digital vascular ischemia
  Contacts and Locations
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Please refer to this study by its identifier: NCT01698593

Canada, New Brunswick
Saint John Regional Hospital
Saint John, New Brunswick, Canada, E2L 4L2
Sponsors and Collaborators
Lalonde, Donald H., M.D.
  More Information

Responsible Party: Lalonde, Donald H., M.D. Identifier: NCT01698593     History of Changes
Other Study ID Numbers: RS#2009-1356
Study First Received: October 1, 2012
Last Updated: October 2, 2012

Keywords provided by Lalonde, Donald H., M.D.:
digital nerve block
duration of action

Additional relevant MeSH terms:
Body Temperature Changes
Signs and Symptoms
Epinephryl borate
Anesthetics, Local
Central Nervous System Depressants
Physiological Effects of Drugs
Sensory System Agents
Peripheral Nervous System Agents
Adrenergic alpha-Agonists
Adrenergic Agonists
Adrenergic Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Adrenergic beta-Agonists
Bronchodilator Agents
Autonomic Agents
Anti-Asthmatic Agents
Respiratory System Agents
Vasoconstrictor Agents processed this record on September 21, 2017