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Wide Awake Local Anesthesia Surgery with Epinepherine is Safe: A Series of 4,287 Consecutive Hand & Upper Extremity Procedures
Asif Ilyas, MD, Orthopaedics, Rothman Institute at Thomas Jefferson University, Philadelphia, PA, Jonas Matzon, MD, Rothman Institute at Thomas Jefferson University, Philadelphia, PA and Ricky Mcentee, BS, Thomas Jefferson University, Philadelphia, PA

INTRODUCTION

Hand and upper extremity surgery performed wide awake involves the use of a local anesthetic and epinephrine. Controversy persists as to whether epinephrine is safe for use in the hand. This study aimed to evaluate the safety of epinephrine in hand and upper extremity surgery. The hypothesis was that epinephrine is safe and may be utilized for a wide breadth of surgical procedures in the hand and upper extremity.

METHODS

A four-year retrospective chart review was conducted of consecutive patients undergoing wide awake surgery with local anesthesia and epinephrine by two surgeons at a single institution. Data collected included patient demographics, procedure volume, procedure types, surgical setting, and complications relating to epinephrine use.

RESULTS

Over the study period, 4,054 consecutive patients underwent 4,287 procedures utilizing wide awake surgery with local anesthesia and epinephrine. The average patient age was 59 years, and 64% of patients were females. There were zero complications related to the use of epinephrine, with no cases of tissue necrosis, phentolamine reversal, anaphylaxis, or readmission. There were no cases where conversion to general anesthesia or monitored anesthesia care was required.

CONCLUSION

This analysis of over 4000 consecutive patients undergoing wide awake hand and upper extremity surgery with epinephrine confirms that epinephrine use is safe; with no cases of tissue necrosis, reversal, readmission, anaphylaxis, or anesthetic conversion identified.


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