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. 2024 Mar;19(2):286-293.
doi: 10.1177/15589447221120843. Epub 2022 Sep 27.

Current Trends in Use of Epinephrine in Hand Surgery

Sumail Bhogal  1 , Aaron Mull  1 , Jonathan Dalton  1 , Raghav Ramraj  1 , Donald Lalonde  2 , John R Fowler  1 , Mark E Baratz  1
Affiliations

Current Trends in Use of Epinephrine in Hand Surgery

Sumail Bhogal et al. Hand (N Y). 2024 Mar.

Abstract

Background: Epinephrine use during hand surgery has been stigmatized due to a fear of digital necrosis. Clinical experience in the past 2 decades has shown epinephrine in local anesthetic to be safe. We sought to analyze the use of epinephrine among hand surgeons and identify variables associated with it.

Methods: A deidentified 21-question survey was distributed via email to the 914 and 415 members of the American Association for Hand Surgery and the Canadian Society for Surgery of the Hand, respectively. Questions included residency type, years of practice, practice setup/ownership, practice leadership, usage of epinephrine, availability of reversal agents, and reasons for or against usage.

Results: Of 188 responders, 170 (90%) used epinephrine in local anesthetic for hand surgery procedures. By nationality, 100% (43) of Canadian surgeons and 89% (108) of US surgeons use epinephrine (P = .01). Among surgeons with practice ownership, 88% (102) used epinephrine compared with 93% (85) of those surgeons that we employed (P = .28). Comparing surgeons with teaching responsibilities versus those without training responsibilities showed that surgeons who did not teach used epinephrine at a higher rate (87% vs 98%, P = .04). In addition, plastic surgery-trained surgeons (111) used epinephrine in 97.2% of cases while orthopedic surgery-trained surgeons (57) used epinephrine in 80.2% of cases (P = .0003). No difference was found when examining the use of epinephrine and surgeon age (P = .28).

Conclusions: Most respondents believe that epinephrine is safe. Training background, location, and practice setup are significant factors in the use of epinephrine, whereas practice ownership and physician age are not major factors.

Keywords: anatomy; epidemiology; hand; research and health outcomes; specialty; surgery; treatment; wrist.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Lalonde has edited a book on wide-awake hand surgery, but receives no money in royalties. All royalties from the book go to the effort of the American Association for Hand Surgery. Dr Baratz receives royalties from Integra Implants and receives payment as a speaker for Integra Implants. Dr Fowler sits on the advisory board for Integra Implants. The other authors have no disclosures or financial/grant support to disclose.

Figures

Figure 1.
Figure 1.
Likert-scale questions that were included to assess physicians’ motivations for and against epinephrine use in surgical procedures.
Figure 2.
Figure 2.
(a) Mean importance ratings ascribed to reasons for epinephrine use. (b) Mean importance ratings ascribed to reasons for avoiding epinephrine use.
See this image and copyright information in PMC

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