Epinephrine with local anesthesia is safe for patients undergoing ‘wide-awake’ hand surgery
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Epinephrine with a local anesthetic is safe and effective with no instances of digital necrosis or need for phentolamine reversal in patients undergoing “wide-awake” hand and upper extremity surgery, according published results.
In their 4-year retrospective chart review, researchers analyzed 4,054 consecutive patients (4,287 procedures) who underwent surgery while they were wide awake. The procedures were performed by two surgeons at a single institution. All patients were given 1:100,000 epinephrine, 9 mL of lidocaine and 1 mL of 8.4% bicarbonate, the standard protocol for wide-awake procedures, according to the study.
Researchers used data on patient demographics, procedure volume, procedure type, surgical setting and complications to determine outcomes. They also noted trigger finger release (1,062 patients), and endoscopic (834 patients) and open carpal tunnel release (798 patients) were the most common procedures performed.
Among the entire cohort, no complications as a result of epinephrine were reported. No tissue necrosis, phentolamine reversal, anaphylaxis, readmissions or conversions to general anesthesia occurred, according to the study.
“The rationale for the use of epinephrine is twofold. First, it minimizes bleeding, which avoids both the need for a tourniquet and the associated pain,” the researchers wrote in the study.
“Most of the data on the safety and effectiveness of wide-awake hand surgery comes from a small number of international institutions and authors,” the researchers wrote. “These findings further challenge the essentially disproven dogma that epinephrine use in the hand is contraindicated.”
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