Tumescent local anesthesia for hand surgery: improved results, cost effectiveness, and wide-awake patient satisfaction

Donald Lalonde, Alison Martin, Donald Lalonde, Alison Martin

Abstract

This is a review article of the wide-awake approach to hand surgery. More than 95% of all hand surgery can now be performed without a tourniquet. Epinephrine is injected with lidocaine for hemostasis and anesthesia instead of a tourniquet and sedation. This is sedation-free surgery, much like a visit to a dental office. The myth of danger of using epinephrine in the finger is reviewed. The wide awake technique is greatly improving results in tendon repair, tenolysis, and tendon transfer. Here, we will explain its advantages.

Keywords: Epinephrine; Local anesthesia; Tourniquet.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Suggested locations and volumes for injecting 1% lidocaine with 1:100,000 epinephrine on the palmar side of the hand
Fig. 2
Fig. 2
Suggested locations and volumes for injecting 1% lidocaine with 1:100,000 epinephrine on the dorsal side of the hand

References

    1. Lalonde DH. Reconstruction of the hand with wide awake surgery. Clin Plast Surg. 2011;38:761–769.
    1. Lalonde D, Martin A. Epinephrine in local anesthesia in finger and hand surgery: the case for wide-awake anesthesia. J Am Acad Orthop Surg. 2013;21:443–447.
    1. Thomson CJ, Lalonde DH, Denkler KA, et al. A critical look at the evidence for and against elective epinephrine use in the finger. Plast Reconstr Surg. 2007;119:260–266.
    1. Terp P. Hydrolysis of procaine in aqueous buffer solutions. Acta Pharmacologica et Toxicologica. 1949;5:353–362.
    1. Uri J, Adler P. The disintegration of procaine solutions. Curr Res Anesth Analg. 1950;29:229–234.
    1. Food and Drug Administration. Warning-procaine solution. JAMA. 1948;138:599.
    1. Denkler K. A comprehensive review of epinephrine in the finger: to do or not to do. Plast Reconstr Surg. 2001;108:114–124.
    1. Nodwell T, Lalonde D. How long does it take phentolamine to reverse adrenaline-induced vasoconstriction in the finger and hand? A prospective, randomized, blinded study: the Dalhousie project experimental phase. Can J Plast Surg. 2003;11:187–190.
    1. Fitzcharles-Bowe C, Denkler K, Lalonde D. Finger injection with high-dose (1:1,000) epinephrine: Does it cause finger necrosis and should it be treated? Hand (N Y) 2007;2:5–11.
    1. Leblanc MR, Lalonde J, Lalonde DH. A detailed cost and efficiency analysis of performing carpal tunnel surgery in the main operating room versus the ambulatory setting in Canada. Hand (N Y) 2007;2:173–178.
    1. Leblanc MR, Lalonde DH, Thoma A, et al. Is main operating room sterility really necessary in carpal tunnel surgery? A multicenter prospective study of minor procedure room field sterility surgery. Hand (N Y) 2011;6:60–63.
    1. Henry SL, Hubbard BA, Concannon MJ. Splinting after carpal tunnel release: current practice, scientific evidence, and trends. Plast Reconstr Surg. 2008;122:1095–1099.
    1. Davison P, Cobb T, Lalonde D. The patient's perspective on carpal tunnel surgery related to the type of anesthesia: a prospective cohort study. Hand. 2013;8:47–53.
    1. Mustoe TA, Buck DW, 2nd, Lalonde DH. The safe management of anesthesia, sedation, and pain in plastic surgery. Plast Reconstr Surg. 2010;126:165e–176e.
    1. Jeske AH. Xylocaine: 50 years of clinical service to dentistry. Tex Dent J. 1998;115:9–13.
    1. Strazar R, Lalonde D. Minimizing injection pain in local anesthesia. CMAJ. 2012;184:2016.
    1. Chatterjee A, McCarthy JE, Montagne SA, et al. A cost, profit, and efficiency analysis of performing carpal tunnel surgery in the operating room versus the clinic setting in the United States. Ann Plast Surg. 2011;66:245–248.
    1. Bismil M, Bismil Q, Harding D, et al. Transition to total one-stop wide-awake hand surgery service-audit: a retrospective review. JRSM Short Rep. 2012;3:23.
    1. McKee DE, Lalonde DH, Thoma A, et al. Optimal time delay between epinephrine injection and incision to minimize bleeding. Plast Reconstr Surg. 2013;131:811–814.
    1. Lalonde DH. "Hole-in-one" local anesthesia for wide-awake carpal tunnel surgery. Plast Reconstr Surg. 2010;126:1642–1644.
    1. Farhangkhoee H, Lalonde J, Lalonde DH. Teaching medical students and residents how to inject local anesthesia almost painlessly. Can J Plast Surg. 2012;20:169–172.
    1. Strazar AR, Leynes PG, Lalonde DH. Minimizing the pain of local anesthesia injection. Plast Reconstr Surg. 2013;132:675–684.
    1. Lalonde DH. Wide-awake flexor tendon repair. Plast Reconstr Surg. 2009;123:623–625.
    1. Higgins A, Lalonde DH, Bell M, et al. Avoiding flexor tendon repair rupture with intraoperative total active movement examination. Plast Reconstr Surg. 2010;126:941–945.
    1. Lalonde D. How the wide awake approach is changing hand surgery and hand therapy: inaugural AAHS sponsored lecture at the ASHT meeting, San Diego, 2012. J Hand Ther. 2013;26:175–178.
    1. 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.

Source: PubMed

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