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American Association of Plastic Surgeons
30. A Multicenter Prospective Analysis of Over 3110 Consecutive Cases of Elective Epinephrine Use in the Fingers and Hand
Donald H. Lalonde, MD1, Michael Bell, MD2, Keith Denkler, MD3, Benoit Paul, MD2, Peter Chang, MD4, Gerald Sparkes, MD1, Patrick Shoemaker, MD5, Arthur Rideout6, Frederick Watkins, MD5.
1Dalhousie University, Saint John, NB, Canada, 2University of Ottawa, Ottawa, ON, Canada, 3University of California, San Francisco, San Francisco, CA, USA, 4University of Saskatchewan, Regina, SK, Canada, 5Queen's University, Kingston, ON, Canada, 6Memorial University, St John's, NF, Canada.

PURPOSE: The purpose of this study was to prospectively examine the incidence of digital infarction, the necessity for phentolamine intervention, and the shift of the surgical venues and costs in a large prospective series of consecutive patients in whom local anesthesia with adrenaline was injected electively into the hand and fingers for hand procedures.
METHODS: From July 2002 to July 2004, 9 hand surgeons in 6 cities prospectively kept accurate records of procedure types, venues, digital infarction and the necessity for phentolamine rescue of each consecutive hand procedure performed with elective hand and finger epinephrine injection.
RESULTS: 3110 consecutive cases of elective injection of low dose epinephrine (1:100,000 or less) in the hand (1770 cases) and fingers (1340 cases) did not produce one case of digital infarction and phentolamine was not required even once to reverse adrenaline vasoconstriction. There was a major shift of operative venue from the main operating room with tourniquet and general anesthesia to the clinic, the emergency department and the office with pure local anesthesia. For example, of the total of 99 flexor tendon repairs in this study, 9 were performed in the main operating room, 51 in the clinic, 36 in the emergency department, and 3 in the office. There was an associated major economic cost saving for this and most other types of hand operations such as carpal tunnel release (1622 cases), Dupuytren’s contracture (203 cases) etc. which will be presented.
CONCLUSION: The true incidence of finger infarction in elective low dose epinephrine injection into the hand and finger is likely to be remote, particularly with the possible rescue with phentolamine. The replacement of the tourniquet and general anesthesia in the main operating room with adrenaline induced vasoconstriction surgery without sedation and without a tourniquet in the emergency department, clinic and office is having a major impact on the venues and costs of many hand operations.

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