Comparison between two mixtures of lidocaine and bupivacaine for infraclavicular block: a double blind randomized trial

El Kaissi Jaber, El Moqaddem Amine, Khalil Mounir, Kechna Hicham, Hachimi Moulay Ahmed, Laoutid Jaouad


Background: We compare the two mixtures in terms of efficiency, analgesia, and side effects.

Methods: 30 patients scheduled for upper limb surgery were randomized in 2 groups. the group A received a mixture of 50% lidocaine 2% and 50% of bupivacaine 0.5% the group B received a mixture of 75% lidocaine 1% and 25% of bupivacaine 0.5%. Volumes, block onset times, blocks duration times, analgesia, and toxicity were compared.

Results: The volumes were equals in both groups. Sensory block onset was 5.43 min in the group A versus 6.73 min in the group B, motor block onset was 11.93 for the group A versus 13.46 min for the group B. Sensory block duration was 5.48 hours in the group A versus 4.05 hours for the group B (p=0.037), motor block duration was 7.75 hours for group A versus 5.50 hours for group B (p=0.014). Analgesia levels are equals between the two groups, there was no side effects listed.

Conclusions: The use of low concentrated lidocaine and bupivacaine mixture induces an adequate anaesthesia and decreases the duration of motor block with a reduced level of pain and an equal level of analgesia.


Analgesia, Local anaesthetics, Nerve block

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Bromage PR, Gertel M. improved brachial plexus blockade with bupivacaine hydrochloride and carbonated lidocaine. Anesthesiology. 1972;36(5):479-87.

Cuvillon P, Zoric L, Ripart J. Comment je gère la durée d’un bloc (dose, concentration, cathéter). Mise au point en anesthésie réanimation. 2011: 83-92.

pour la Pratique Clinique R. Blocs périphériques des membres chez l’adulte. Paris, SFAR. 2003;22:567-81.

Vasques F, Behr AU, Weinberg G, Ori C, Di Gregorio G. A review of local anesthetic systemic toxicity cases since publication of the American society of regional anaesthesia recommendations: to whom it may concern. Reg Anesth Pain Med. 2015;40:698-705.

Choi J, Gadsden J. Local anaesthetic mixtures for peripheral nerve blocks. In: Hadzic A, ed. Hadzic’s textbook of regional anaesthesia and acute pain management. Mcgraw hill; 2017.

Beloeil H, Mazoit JX. Pharmacologie des anesthésiques locaux. EMC (Elsevier Masson SAS, Paris), Anesthésie-Réanimation. 2010;36:320-A-10.

Cuvillon P, Boisson C, Ripart J. Il ne faut plus mélanger les anesthésiques locaux pour faire des blocs. Le praticien en anesthésie réanimation: 2012;16(2):71-3.

Clarkson CW, Hondeghem LM. Evidence for a specific receptor site for lidocaine, quinidine, and bupivacaine associated with cardiac sodium channels in guinea pig ventricular myocardium. Circ Res 1985;56:496-506.

Daos F, Lopez L, Virtue R. Local anaesthetic toxicity modified by oxygen- and by combination of agents. Anesthesiology. 1962;23:755-61.

Lefrant JY, Muller L, de La Coussaye JE, Lalourcey L, Ripart J, Peray PA, et al. Hemodynamic and cardiac electrophysiologic effects of lidocaine-bupivacaine mixture in anesthetized and ventilated piglets. Anesthesiology. 2003;98:96-103.

Munson E, Paul W, Embro W. Central nervous toxicity of local anesthesic mixtures in monkeys. Anesthesiology. 1977,46:179-83.

De Jong R, Bonin J. Mixtures of local anaesthetics are no more toxic than the parent drugs. Anesthesiology. 1981;54:177-81.

Spiegel D, Dexter F, Warner DS, Baker MT, Todd MM. Central nervous system toxicity of local anesthetic mixtures in the rat. Anesth Analg. 1992;75:922-8.

Cuvillon P, Nouvellon E, Ripart J, Boyer JC, Dehour L, Mahamat A, et al. A comparison of the pharmacodynamics and pharmacokinetics of bupivacaine, ropivacaine (with epinephrine) and their equal volume mixtures with lidocaine used for femoral and sciatic nerve blocks: a double-blind randomized study. Anesth Analg. 2009;108:641-9.

Reinikainen M, Hedman A, Pelkonen O, Ruokonen E. Cardiac arrest after interscalene brachial plexus block with ropivacaine and lidocaine. Acta Anaesthesiol Scandinav. 2003;47:904-6.

Ozmen O, Alici HA, CeLiK M, Dostbil A, Cesur M. Effect of addition of lidocaine to bupivacaine on anaesthesia beginning time, block time, and block quality in lateral sagittal infraclavicular block. Turk J Med Sci. 2013;43:542-7.

Nishiyama T. Comparison of the motor and sensory block by ropivacaine and bupivacaine in combination with lidocaine in interscalene block. Med Arch. 2012;66(5):315-7.

Duncan M, Shetti AN, Tripathy DK, Roshansingh D, Krishnaveni N. A comparative study of nerve stimulator versus ultrasound-guided supraclavicular brachial plexus block. Anesth Essays Res. 2013;7:359-64.