Wide-Awake Surgery With Local Anesthesia and Epinephrine Is Safe

Abstract

Hand and upper extremity surgery performed with the patient wide awake involves the use of a local anesthetic and epinephrine. Controversy persists as to whether epinephrine is safe for use in the hand. The goal of this study was to evaluate the safety of epinephrine in hand and upper extremity surgery. The hypothesis was that epinephrine is safe and can be used for a wide breadth of surgical procedures of the hand and upper extremity. A 4-year retrospective chart review was conducted of consecutive patients undergoing wide-awake surgery performed by 2 surgeons at a single institution. All procedures were performed with local anesthesia and epinephrine. Data collected included patient demographics, procedure volume, procedure type, surgical setting, and complications related to epinephrine use. During the study period, 4054 consecutive patients underwent 4287 wide-awake procedures with local anesthesia and epinephrine. Average patient age was 59 years, and 64% of patients were female. No complications occurred as a result of the use of epinephrine, and no tissue necrosis, phentolamine reversal, anaphylaxis, or readmissions occurred. No patients required conversion to general anesthesia or monitored anesthesia care. This analysis of more than 4000 consecutive patients undergoing wide-awake hand and upper extremity surgery with epinephrine confirmed that epinephrine use is safe, with no reported cases of tissue necrosis, reversal, readmission, anaphylaxis, or anesthetic conversion. Epinephrine is safe for use in the hand and upper extremity for patients undergoing wide-awake hand surgery with a local anesthetic. [ Orthopedics . 2020;43(6):e529–e532.]

In-Office Needle Tendoscopy of the Tibialis Posterior Tendon with Concomitant Intervention

“…Wide-awake surgical procedures have been successfully used to manage select upper and lower extremity pathology. 16 , 17 , 18 , 19 , 20 Patient feedback after these interventions has been overall positive with a high rate willing to undergo a similar treatment. 21 , 22 Indeed, our own patients have been grateful to have an opportunity to watch their arthroscopy in real-time and interact with the operative team.…”

The Impact of Intraoperative Nursing Care on Perioperative Complications During Wide-Awake Local Anesthesia Hand Surgery

“…As indications continue to expand for the use of wide-awake local anesthesia in hand surgery, the benefits of the technique in terms of cost savings, time efficiency, patient safety, and patient satisfaction will become increasingly apparent. 10 , 11 Therefore, it is important for facilities to use the best available evidence when adopting protocols for the use of this technique. This will allow them to realize these same benefits.…”

Flexor tendon laceration of the hand from opening a glass ampoule

“…In a retrospective review of 1073 cases of WALANT surgery in hand and finger surgeries, there were no reported instances of circulatory or ischaemic problems. 21 In a retrospective review of 4287 wide awake procedures with local anaesthesia and epinephrine, Ilyas et al 22 reported that there were no instances of tissue necrosis, vascular compromise or phentolamine reversal. This large series on the use of 1:100 000 epinephrine with local anaesthesia showed that it is safe for hand surgery procedures.…”