Update/Review: changing of use of local anesthesia in the hand

Sarah Al Youha, Donald H Lalonde, Sarah Al Youha, Donald H Lalonde

Abstract

Among the many advances in local anesthesia of the hand, some of the most significant changes in the last 5 years have been the following: (1) the acceptance of safety of locally infiltrated epinephrine with lidocaine for hemostasis, which has removed the need for sedation, brachial plexus blocks, and general anesthesia for most common hand surgery operations and minor hand trauma. (2) The elimination of the 2 injection finger block technique in favor of the single injection palmar block. (3) Local anesthesia can now be consistently injected in the hand with minimal pain. (4) Liposomal release of local anesthetic after injection into the surgical site can provide pain control up to 3 days. This article reviews the impact and best evidence related to these changes.

Figures

Fig. 1.
Fig. 1.
Local anesthesia injection for extensor indicis to extensor pollicis longus tendon transfer. The circled area was injected with 30 ml of 1% lidocaine with 1:100,000 epinephrine 30 minutes before the operative procedure. Red lines indicate incisions. Purple lines outline the extensor indicis proprius and extensor pollicis longus tendons. Reprinted with permission from Bezuhly M, Sparkes GL, Higgins A, et al. Immediate thumb extension following extensor indicis proprius-to-extensor pollicis longus tendon transfer using the wide-awake approach. Plast Reconstr Surg. 2007;119:1507–1512.
Fig. 2.
Fig. 2.
SIMPLE block—Single Subcutaneous Injection in the Middle of the Proximal Phalanx with Lidocaine and Epinephrine (2 ml).
Video 1.
Video 1.
See video, Supplemental Digital Content 1, which demonstrates wide awake flexor tendon repair in Part 1, http://links.lww.com/PRSGO/A32, and tenolysis, carpal tunnel, Dupuytren, trigger finger, thumb ligament repair, thumb fusion, hand fractures, spaghetti wrist, and tendon transfer in Part 2, http://links.lww.com/PRSGO/A34. Reprinted with permission from Mustoe TA, Buck DW II, Lalonde DH. The safe management of anesthesia, sedation and pain in plastic surgery. Plast Reconstr Surg. 2010;126:165e–176e.
Video 2.
Video 2.
See video, Supplemental Digital Content 2, which demonstrates how to inject local anesthesia with minimal pain for carpal tunnel surgery, http://links.lww.com/PRS/A212. Reprinted with permission from Lalonde DH. “Hole-in-one” local anesthesia for wide-awake carpal tunnel surgery. Plast Reconstr Surg. 2010;126:1642–1644.

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