The safety and efficacy of epinephrine in hand surgery

A systematic review of the literature and international survey

Sachin M. Shridharani, Paul Manson, Michael Magarakis, Justin M. Broyles, Iain S. Whitaker, Eduardo D. Rodriguez

Research output: Contribution to journalArticle

Abstract

The concept that epinephrine-based local anesthetics cannot be injected in terminal appendages has been perpetuated for decades. The hypothesis that the vasoconstrictive effect of epinephrine will result in finger necrosis has been accepted as fact, often preventing its use in hand surgery. To scientifically challenge this hypothesis, a systematic review of the literature was performed, and a survey of ASPS members reported to highlight the lack of evidence-based opinions. A systematic literature review performed using Medline, Embase, PubMed, and Cochrane databases identified all published studies evaluating use of epinephrine/adrenaline in hand, finger or digit surgery. Each study was independently evaluated by three reviewers for inclusion or exclusion from the systematic review. Additionally, a survey (E-survey link) was distributed to all ASPS members and data were collected over a 5-month period through SurveyMonkey®. A total of 568 articles published prior to December 2012 were identified. After elimination of 151 duplicates, 417 articles remained. Fifty-five articles were selected and full examination of the texts was performed. Forty-five studies matched the selection criteria and were included in the analysis. The ASPS member survey demonstrated a 13 % overall questionnaire response rate (5,299 questionnaires/687 responses). Of all respondents, 37.4 % felt it was unsafe to inject local anesthesia mixed with epinephrine into the fingers/thumb, respectively. Critical literature review validated the safety and efficacy of utilizing epinephrine-based local anesthetics. The author's survey elucidates the pervasive concern of employing epinephrine in hand surgery. Level of Evidence: Not ratable.

Original languageEnglish (US)
Pages (from-to)183-188
Number of pages6
JournalEuropean Journal of Plastic Surgery
Volume37
Issue number4
DOIs
StatePublished - 2014

Fingerprint

Epinephrine
Hand
Safety
Fingers
Local Anesthetics
Surveys and Questionnaires
Thumb
Local Anesthesia
PubMed
Patient Selection
Necrosis
Databases

Keywords

  • Adrenaline
  • Epinephrine
  • Evidence-based medicine
  • Hand surgery
  • Plastic surgery
  • Survey

ASJC Scopus subject areas

  • Surgery

Cite this

The safety and efficacy of epinephrine in hand surgery : A systematic review of the literature and international survey. / Shridharani, Sachin M.; Manson, Paul; Magarakis, Michael; Broyles, Justin M.; Whitaker, Iain S.; Rodriguez, Eduardo D.

In: European Journal of Plastic Surgery, Vol. 37, No. 4, 2014, p. 183-188.

Research output: Contribution to journalArticle

Shridharani, Sachin M. ; Manson, Paul ; Magarakis, Michael ; Broyles, Justin M. ; Whitaker, Iain S. ; Rodriguez, Eduardo D. / The safety and efficacy of epinephrine in hand surgery : A systematic review of the literature and international survey. In: European Journal of Plastic Surgery. 2014 ; Vol. 37, No. 4. pp. 183-188.
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