In children (4 years and below), administration of local anesthesia prior to incision is a low risk and easy way to minimize the cumulative sevoflurane dosage for trigger thumb release.

A randomized controlled trial was performed to assess whether local anesthetic injection prior to surgical incision reduced inhalational anesthetic exposure in pediatrics undergoing trigger thumb release. Also, whether timing of local anesthetic injection influenced post-surgery pain or length of stay was investigated.

In this trial, children were randomly assigned into either preincision (n=13) or postrelease local anesthesia injection (n=11) groups. Collection of patient demographics, operative times, postoperative anesthesia care unit recovery characteristics, and cumulative sevoflurane dose was done. The Mann-Whitney U tests, χ2, and Fisher exact were carried out.

In total, 24 volunteers were recruited in this single-center study. Regarding tourniquet time, age, sex, operative time, no profound inter-group difference was noted. A considerable difference was witnessed in cumulative sevoflurane dose between postprocedure injection arm (28.1 vol%) and preincision injection arm (23.2 vol%), indicating a 21% decrease in cumulative dose.

No substantial differences were noted in postoperative pain scores, usage of rescue pain medicines, nausea incidence, or the time to discharge between the groups.

Injecting local anesthetic prior to incision (when compared to at the end of the procedure) remarkably decrease general anesthesia needs during unilateral trigger thumb release, can lower sevoflurane exposure more substantially in longer procedures and alleviate neurotoxicity risks. Hence, in routine clinical practice, preincision injection with local anesthetic must be included.