Use of adrenalin with lidocaine in hand surgery

Ronaldo Antonio de Freitas Novais Junior, Jorge Ribamar Bacelar Costa, Jose Mauricio de Morais Carmo

Because of the received wisdom within our setting that claims that local anesthesia should not be used with adrenalin in hand surgery; we conducted a study using lidocaine with adrenalin, to demonstrate its safety, utility and efficacy. We conducted a prospective study in which, in wrist, hand and finger surgery performed from July 2012 onwards, we used local anesthesia comprising a 1% lidocaine solution with adrenalin at 1:100,000. We evaluated the quantity of bleeding, systemic alterations, signs of arterial deficit and complications, among other parameters. We described the infiltration techniques for specific procedures individually. We operated on 41 patients and chose to describe separately the raising of a lateral microsurgical flap on the arm, which was done without excessive bleeding and within the usual length of time. In only three cases was there excessive bleeding or use of bipolar tweezers. No systemic alterations were observed by the anesthesiologists or any complications relating to ischemia and necrosis in the wounds or in the fingers, and use of tourniquets was not necessary in any case. Use of lidocaine with adrenalin in hand surgery was shown to be a safe local anesthetic technique, without complications relating to necrosis. It provided efficient exsanguination of the surgical field and made it possible to perform the surgical procedures without using a pneumatic tourniquet, thereby avoiding its risks and benefiting the patient through lower sedation.