• Hafsa Ahmad, Hussan Birkhez Shami, Saadia Nosheen Jan, Zahid Tayab, and Muhammad Mustehsan Bashir.
• Department of Plastic Surgery, Mayo Hospital, Lahore, Pakistan.
• J Coll Physicians Surg Pak. 2023 Jul 1; 33 (7): 727731727-731.

ObjectiveThis study aims to determine the minimal concentration of lidocaine to provide adequate analgesia in wide awake local anaesthesia no tourniquet (WALANT) hand surgeries comparing 3 dilutions of tumescent lidocaine with epinephrine solution.Study DesignA randomised control trial. Place and Duration of the Study: The study was held at the Plastic Surgery Department of Mayo Hospital, Lahore, from September 2020 to March 2021.MethodologyInclusion criteria were post-traumatic hand contractures and tendon and nerve injuries. The patients were randomised to 3 groups of 30 each: Group A (0.1% lidocaine), Group B (0.2% lidocaine), and Group C (0.3% lidocaine). The dilution of adrenaline also remained constant at 1:200,000. Pain was measured using the Visual Analogue Scale. The three groups were compared for demographics and the total duration of analgesia in minutes.ResultsAll groups showed adequate pain relief during surgery with no cases requiring conversion to general anaesthesia. The highest total duration of analgesia was seen in the 0.3% group (805.3±195.2 minutes), followed by the 0.2% group (500.4±87.2 minutes) and 0.1% group (381.3±31.6 minutes) (p<0.05). No patient developed any signs of lidocaine toxicity. A low Lidocaine concentration of 0.1% was effective in providing analgesia during surgery though increasing the lidocaine concentration to 0.3% would result in greater post-operative analgesic time without increasing toxicity.ConclusionAdequate analgesia was recorded with all 3 lidocaine concentrations. The greatest pain-free duration was however observed in the  0.3% lidocaine group.Key WordsWide awake local anaesthesia no tourniquet (WALANT), Lidocaine concentrations, Hand surgery, Analgesia, Adverse effects.

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