Elsevier

The Journal of Hand Surgery

Volume 30, Issue 5, September 2005, Pages 1061-1067
The Journal of Hand Surgery

Original article
Local anesthesia
A Multicenter Prospective Study of 3,110 Consecutive Cases of Elective Epinephrine Use in the Fingers and Hand: The Dalhousie Project Clinical Phase

https://doi.org/10.1016/j.jhsa.2005.05.006Get rights and content

Purpose

To examine prospectively the incidence of digital infarction and phentolamine rescue in a large series of patients in whom local anesthesia with adrenaline was injected electively into the hand and fingers. There continues to be a commonly held belief that epinephrine injection is contraindicated in the finger despite a lack of valid evidence to support this concept in the literature.

Methods

From 2002 to 2004 there were 9 hand surgeons in 6 cities who prospectively recorded each consecutive case of elective hand and finger epinephrine injection. They recorded each instance of skin or tissue loss and the number of times phentolamine reversal of adrenaline vasoconstriction was required.

Results

There were 3,110 consecutive cases of elective injection of low-dose epinephrine (1:100,000 or less) in the hand and fingers and none produced any instance of digital tissue loss. Phentolamine was not required to reverse the vasoconstriction in any patients.

Conclusions

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.

Section snippets

Materials and Methods

After obtaining institutional review board approval for this study 9 hand surgeons in 6 cities began prospectively keeping accurate records of cases in which they previously had been using elective epinephrine routinely for years.

From July 2002 to July 2004 they recorded each patient’s procedure; age; which anesthetic agent was used with the epinephrine (lidocaine or bupivicaine); the occurrence of digital infarction, skin necrosis, or tissue loss of any kind; whether the adrenaline was

Results

In all of the 3,110 cases of hand and finger injections there were no cases of finger infarction, skin necrosis, or tissue loss of any kind. There were no instances in which phentolamine had to be injected to reverse epinephrine-induced vasoconstriction.

The types of procedures and the locations of execution in which 1,340 fingers were injected are listed in Table 1 and the procedures and locations for 1,770 hand cases are listed in Table 2.

The most common types of finger cases were 428

Discussion

This study reports 3,110 consecutive cases of low-dose elective adrenaline (≤1:100,000) injection into 1,770 hands and 1,340 fingers without a single case of digital tissue loss or infarction. Just as important, none of the cases required the injection of phentolamine to reverse the vasoconstrictive effect of the epinephrine.

The experimental phase of the Dalhousie project showed that phentolamine consistently and reliably reverses adrenaline vasoconstriction in the finger in an average of 1

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