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