Authors: Yousef S et al.
European Journal of Anaesthesiology 42(12):1046–1055, December 2025
DOI: 10.1097/EJA.0000000000002261
Summary
This randomized, blinded, active-controlled trial evaluated whether mixing lidocaine–epinephrine with ropivacaine alters the duration of analgesia or onset time in lateral infraclavicular brachial plexus blocks. Seventy-eight patients undergoing hand surgery were randomized into three groups: full-dose ropivacaine (R150), reduced-dose ropivacaine plus lidocaine–epinephrine (R100–L200), or full-dose ropivacaine plus lidocaine–epinephrine (R150–L200).
The primary finding was a clear reduction in block duration whenever lidocaine–epinephrine was added. Pure ropivacaine (R150) produced an average analgesia duration of 847 minutes. Adding lidocaine–epinephrine reduced duration by 311 minutes in the R100–L200 group and by 177 minutes in the R150–L200 group. The two mixture groups did not differ significantly from each other after statistical adjustment. Importantly, sensory onset time remained the same across all groups, averaging 17–18 minutes, indicating that lidocaine–epinephrine did not provide any meaningful onset advantage.
Overall, combining lidocaine–epinephrine with ropivacaine substantially shortened the duration of analgesia—up to five hours—regardless of whether standard or higher-concentration ropivacaine was used, and without improving onset.
What You Should Know
• Seventy-eight patients randomized to pure ropivacaine or mixtures with lidocaine–epinephrine.
• Adding lidocaine–epinephrine consistently reduced analgesia duration by 3–5 hours.
• Higher-dose ropivacaine did not prevent the shortening effect.
• Sensory onset time was unchanged at approximately 17–18 minutes.
• Mixing short- and long-acting agents reduced block duration without providing a faster onset.
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