Wide Awake Trigger Finger Release Surgery

摘要

Trigger finger is one of the most common conditions treated by hand surgeons with a lifetime risk estimated at 2.6% in the general population and 4% to 10% in patients with diabetes.7,8,13,17 It is generally characterized by pain, swelling, limitation of finger motion, and a triggering sensation caused by thickening of the A1 pulley and/or localized thickening of the tendon with resultant entrapment of the flexor tendons.14Conservative treatments are typically attempted first, including activity modification, splinting, physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroid injections, all of which have demonstrated varying degrees of success.13,14 If conservative management fails, surgical treatment is recommended that can result in up to a 100% success rate.3 Surgery is traditionally performed with or without sedation and a tourniquet, via a small incision at the level of the volar aspect of the metacarpal head followed by exposure and longitudinal release of the A1 pulley.A number of local anesthetics are readily available and utilized in hand surgery including but not limited to ropivacaine, Lidocaine and Marcaine. Recently, Exparel (Pacira, Parsippany, New Jersey) has been introduced which is an extended-release liposomal Marcaine-based analgesic that was granted FDA approval in 2011 for postsurgical analgesia through single-dose local administration into the surgical wound.15 The extended-release formulation consists of a microscopic, spherical, lipid-based delivery system, which allows for diffusion of Marcaine over an extended period, resulting in purported pain relief for up to 96 hours after surgery. Since its introduction, there have been numerous reports of successfully achieving prolonged pain relief with Exparel after various procedures such as breast augmentation, bunionectomy, hernia repairs, and total knee arthroplasty.1,9,21 However, currently there are no studies on Exparel in hand surgery.In this study, we prospectively evaluated the efficacy Lidocaine, Marcaine, or Marcaine with postoperative Exparel in controlling postoperative pain, opioid usage, and adverse reactions following trigger finger release (TFR) surgery performed wide awake without sedation or a tourniquet. The study hypothesis was that Exparel would result in lower postoperative pain and opioid consumption than with Lidocaine and Marcaine.