{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T23:52:15Z","timestamp":1790725935266,"version":"4.1.0"},"reference-count":87,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T00:00:00Z","timestamp":1695859200000},"content-version":"vor","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Cancer Institute Cancer Center","award":["P30 CA008748"],"award-info":[{"award-number":["P30 CA008748"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Conflicting evidence exists regarding the optimal waiting time for stable analgesic and vasoconstrictive effects after local infiltration of lidocaine with epinephrine. An objective review is needed to dispel surgical dogma.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This systematic review (PROSPERO ID: CRD42022362414) included RCTs and prospective cohort studies. Primary outcomes were (1) onset of analgesia and (2) onset of stable hypoperfusion, assessed directly, or measured indirectly using perfusion imaging. Other data extracted include waiting strategies, means of outcome assessment, anaesthetic concentrations, volume\/endpoint of infiltration, and injection sites. Methodological quality was evaluated using the Cochrane risk-of-bias tool for randomized trials. Articles describing waiting strategies were critically appraised by the Joanna Briggs Institute tools.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Twenty-four articles were analysed, comprising 1013 participants. Ten investigated analgesia onset. Their pooled mean was 2.1\u2005min (range 0.4\u20139.0\u2005min). This varied with anatomic site and targeted nerve diameter. Fourteen articles investigated onset of stable hypoperfusion. Four observed bleeding intraoperatively, finding the minimum time to hypoperfusion at 7.0\u2005min in the eyelid skin and 25.0\u2005min in the upper limb. The ten remaining studies used perfusion imaging, reporting a wide range of results (0.0\u201330.0\u2005min) due to differences in anatomic sites and depth, resolution and artefacts. Studies using near-infrared reflectance spectroscopy and hyperspectral imaging correlated with clinical observations. Thirteen articles discussed waiting strategies, seven relating to large-volume tumescent local infiltration anaesthesia. Different waiting strategies exist for emergency, arthroscopic and cosmetic surgeries, according to the degree of hypoperfusion required. In tumescent liposuction, waiting 10.0\u201360.0\u2005min is the norm.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Current literature suggests that around 2\u2005min are required for most patients to achieve complete analgesia in all sites and with all anaesthesia concentrations. Waiting around 7\u2005min in eyelids and at least 25\u2005min in other regions results in optimal hypoperfusion. The strategies discussed inform decisions of when and how long to wait.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrad089","type":"journal-article","created":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T16:54:16Z","timestamp":1695920056000},"source":"Crossref","is-referenced-by-count":17,"title":["How long to wait after local infiltration anaesthesia: systematic review"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8485-4366","authenticated-orcid":false,"given":"Mohammad Suleman","family":"Bajwa","sequence":"first","affiliation":[{"name":"Department of Plastic & Reconstructive Surgery\/Mayo Burn Centre, Mayo Hospital, King Edward Medical University , Lahore , Pakistan"},{"name":"Department of Surgery, Montefiore Medical Center , New York , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Mustehsan","family":"Bashir","sequence":"additional","affiliation":[{"name":"Department of Plastic & Reconstructive Surgery\/Mayo Burn Centre, Mayo Hospital, King Edward Medical University , Lahore , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Hamza","family":"Bajwa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Aga Khan University , Karachi , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zafar","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Department of Plastic & Reconstructive Surgery\/Mayo Burn Centre, Mayo Hospital, King Edward Medical University , Lahore , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Aizaz","family":"Salahuddin","sequence":"additional","affiliation":[{"name":"Department of Plastic & Reconstructive Surgery\/Mayo Burn Centre, Mayo Hospital, King Edward Medical University , Lahore , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Hussain","sequence":"additional","affiliation":[{"name":"Department of Plastic & Reconstructive Surgery\/Mayo Burn Centre, Mayo Hospital, King Edward Medical University , Lahore , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farooq","family":"Shahzad","sequence":"additional","affiliation":[{"name":"Plastic & Reconstructive Surgery Service, Memorial Sloan-Kettering Cancer Center , New York, New York , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,9,28]]},"reference":[{"key":"2023092813253247200_zrad089-B1","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.3390\/jcm11041123","article-title":"Less fluctuation in hemodynamics of the wide-awake local anesthesia no tourniquet technique than general anesthesia in distal radius plating surgery: a prospective case\u2013control 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