Reduced painful facial infiltration with mixture of lignocaine–bupivacaine in comparison to individual agents

The anecdotal use of lignocaine and bupivacaine mixture as local anaesthetics (LA) in minor surgical operations is increasingly popular, despite a lack of evidence to support this practice. The infiltration of LA is frequently identified as the most unpleasant aspect of the whole surgical procedure. This study compared the level of infiltration associated pain when 1% lignocaine, 0.25% bupivacaine and their 1:1 (v:v) mixture were used in patients undergoing minor facial procedure. A prospective, randomised study was carried out on patients undergoing minor facial procedure at the day surgery unit. The Visual Analogue Score (VAS) at the time of infiltration, injected volume and number of injections were recorded and analysed between groups. A total of 94 patients were recruited. The average volume of LA injected was 2.5 ± 1.9 ml and the average number of injections was 2.3 ± 1.5. The lignocaine–bupivacaine mixture (VAS = 3.1 ± 0.4) was identified as the least painful agent (p < 0.05), when compared to 1% lignocaine (VAS = 4.6 ± 0.4) and 0.25% bupivacaine (VAS = 6.4 ± 0.5). In this cohort, female patients consistently reported a lower VAS score for all groups, but this observation was not statistically significant (p > 0.05) when compared to male patients. The mixture of lignocaine and bupivacaine was associated with less pain during skin infiltration when compared to individual agents. Thus, we recommend its use in facial surgical procedures involving LA as this practice allows us to improve patients comfort during their surgery.