TY - JOUR
T1 - The safety and efficacy of epinephrine in hand surgery
T2 - A systematic review of the literature and international survey
AU - Shridharani, Sachin M.
AU - Manson, Paul N.
AU - Magarakis, Michael
AU - Broyles, Justin M.
AU - Whitaker, Iain S.
AU - Rodriguez, Eduardo D.
PY - 2014/4
Y1 - 2014/4
N2 - 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.
AB - 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.
KW - Adrenaline
KW - Epinephrine
KW - Evidence-based medicine
KW - Hand surgery
KW - Plastic surgery
KW - Survey
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U2 - 10.1007/s00238-013-0925-1
DO - 10.1007/s00238-013-0925-1
M3 - Review article
AN - SCOPUS:84896542788
SN - 0930-343X
VL - 37
SP - 183
EP - 188
JO - European Journal of Plastic Surgery
JF - European Journal of Plastic Surgery
IS - 4
ER -