Epinephrine and Hand Surgery

Dosage of Local Anesthesia in Wide Awake Hand Surgery

“…Epinephrine safety in the finger is well established. 2 A 27-gauge needle hurts less going in the skin than a 25-gauge needle and helps remind the injector to slow down. Begin by injecting 2 cc slowly, just below the skin.…”

“…Similar to when they are having a dental procedure, patients who understand and are offered the wide awake alternative like the ideas of (1) no preoperative testing, (2) no tourniquet pain, (3) less time at the hospital to have the surgery, (4) the ability to speak to their surgeon during the surgery, and (5) no sedation to cloud their head when they get home from their surgery. 1 …”

Buffered lidocaine and bupivacaine mixture the ideal local anesthetic solution

“…Lalonde and Martin (19) and others (20,21) have provided a tremendously positive service to practitioners and the patients we serve by their work to debunk the traditional teaching of avoidance epinephrine-containing LAs in digits. It is the senior author's (TJB) opinion, that this can be safely extended to all 'end-artery' body parts -the nose, ears, penis, etc.…”

Use of WALLANT technique in hand surgery, safe and advantageous. Personal experience

“…In 2007, FitzcharlesBowe reported that there was no finger necrosis after accidental digital injection of high-dose (1:1,000) epinephrine (6). Studies on the effects of epinephrine use in local anesthesia in hand surgery have been also conducted by Chowdhry (2010), Muck (2010) and Mann (2012) (7)(8)(9). Lalonde established in 2013 the dosage of 1% lidocaine with 1:100,000 epinephrine for the typical surgical procedures, recommending the use of 20 cc for CTS, 4 cc for trigger finger, 15 cc for each digital ray affected by DD, 40 cc for Bennet fracture and metacarpal fractures (10).…”