Authors: Bouts Cédric, Van Boxstael Sam, Vandepitte Catherine, Leunen Ine, Hassanin Jalil, Louage Sofie, Kuroda Maxine M, Alexander Vloka, Hadzic Admir.
Aim: Skin infiltration with local anesthetic is commonly used to decrease patient discomfort during the administration of peripheral nerve blocks. Topically applied local anesthetic gel could provide analgesia while eliminating the need for additional injections of local anesthetics prior to placing the blocks. The primary objective of this study was a noninferiority comparison of the analgesia achieved for needle insertion and injection pain by applying a topical local anesthetic gel or by infiltrating a local anesthetic to the area for placement of an interscalene or axillary brachial plexus block.
Methods: Thirty subjects undergoing surgery of the upper limb were randomized into three treatment groups. Group 1 received 10 g (10 mL) topical lidocaine 2% gel applied to the skin surface over the brachial plexus, Group 2 received a skin infiltration in the same area with 3 cc lidocaine 2%, and Group 3 received aqueous non-medicated ultrasound gel applied over the interscalene space. These treatments were applied 5 min prior to placement of the nerve block. Primary outcome variables were Visual Analogue Scale (VAS) pain scores during needle insertion and injection. Fearfulness of the nerve block was by verbal report on a 5-point Likert scale.
Results: Topical lidocaine 2% gel was found to be noninferior to lidocaine infiltration in improving pain during needle insertion and injection of the interscalene and axillary brachial plexus blocks.
Conclusion: Analgesia conferred by application of lidocaine gel is noninferior to that of infiltration with lidocaine 2% for pain during needle insertion and injection of the interscalene and axillary brachial plexus blocks.
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