• Muhammad Mustehsan Bashir, Rehan Qayyum, Muhammad Hammad Saleem, Kashif Siddique, and Farid Ahmad Khan.
• Plastic Surgery Department, King Edward Medical University, Mayo Hospital Lahore, Lahore, Punjab, Pakistan. Electronic address: mmb166@yahoo.com.
• J Hand Surg Am. 2015 Aug 1; 40 (8): 1606-9.

PurposeTo determine the optimal time interval between tumescent local anesthesia infiltration and the start of hand surgery without a tourniquet for improved operative field visibility.MethodsPatients aged 16 to 60 years who needed contracture release and tendon repair in the hand were enrolled from the outpatient clinic. Patients were randomized to 10-, 15-, or 25-minute intervals between tumescent anesthetic solution infiltration (0.18% lidocaine and 1:221,000 epinephrine) and the start of surgery. The end point of tumescence anesthetic infiltration was pale and firm skin. The surgical team was blinded to the time of anesthetic infiltration. At the completion of the procedure, the surgeon and the first assistant rated the operative field visibility as excellent, fair, or poor. We used logistic regression models without and with adjustment for confounding variables.ResultsOf the 75 patients enrolled in the study, 59 (79%) were males, 7 were randomized to 10-minute time intervals (further randomization was stopped after interim analysis found consistently poor operative field visibility), and 34 were randomized to the each of the 15- and 25-minute groups. Patients who were randomized to the 25-minute delay group had 29 times higher odds of having an excellent operative visual field than those randomized to the 15-minute delay group. After adjusting for age, sex, amount of tumescent solution infiltration, and duration of operation, the odds ratio remained highly significant.ConclusionsWe found that an interval of 25 minutes provides vastly superior operative field visibility; 10-minute delay had the poorest results.Type Of Study/Level Of EvidenceTherapeutic I.Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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