Adding adrenaline to bupivacaine for lipoma plane block reduces blood loss and pain

BACKGROUND: Adrenaline is commonly added to local anesthetic solutions to reduce bleeding and prolong analgesia. However, its clinical impact during ultrasound-guided interfascial plane blocks in superficial soft tissue surgery remains insufficiently evaluated. This randomized controlled trial assessed the effect of adding adrenaline (1:200,000) to bupivacaine during ultrasound-guided lipoma plane block. METHODS: In this prospective randomized controlled study, 40 adult patients undergoing elective superficial lipoma excision were randomly assigned to two groups (20 patients each). Group A received 0.25% bupivacaine with adrenaline (1:200,000), and Group B received 0.25% bupivacaine alone. Primary outcomes were intraoperative blood loss, operative time, and postoperative pain scores at 2, 6, and 24 hours. Secondary outcomes included need for rescue analgesia, supplemental anesthesia, ease of dissection, capsule integrity, and postoperative complications. Statistical significance was defined as p < 0.05. RESULTS: Baseline characteristics were comparable between groups. Intraoperative blood loss was significantly lower in Group A (6.2 ± 1.5 mL) compared with Group B (12.7 ± 2.8 mL; p < 0.001). Operative time was shorter in the adrenaline group (12.4 ± 3.1 min vs. 17.8 ± 3.9 min; p = 0.002). Postoperative pain scores were significantly lower in Group A at 2 hours (p = 0.004), 6 hours (p = 0.006), and 24 hours (p = 0.009). Rescue analgesia was required less frequently in Group A (15% vs. 40%; p = 0.038). Ease of dissection and capsule integrity preservation were significantly improved with adrenaline. Minor hematoma occurred less frequently in Group A (5% vs. 20%; p = 0.041). No serious adverse events were observed. CONCLUSIONS: The addition of adrenaline (1:200,000) to bupivacaine in ultrasound-guided lipoma plane block significantly reduces intraoperative blood loss, shortens operative time, and improves postoperative analgesia. Adrenaline appears to be a safe and effective adjunct in superficial lipoma excision.