Epinephrine and hand surgery.

PURPOSE: The growing emphasis on value-based care and the adoption of the "Wide Awake Local Anesthesia with No Tourniquet" (WALANT) surgical technique have led to increased use of epinephrine in hand surgery. Although this practice is considered safe, some surgeons still worry about elective epinephrine use in the finger. The aim of this systematic review was to determine the rate of ischemic complications associated with epinephrine use in hand surgery to better inform surgeons and patients.

METHODS

A systematic search of the Scopus database was conducted for studies published between 2005 and 2022. Of 1477 studies identified, 1339 were excluded after title and abstract screening and 138 after full-text review, leaving 51 studies for the final review. Inclusion criteria were hand surgery patients with epinephrine injected into the hand (carpus and distal). Exclusion criteria were case reports, reviews, animal studies, cadaveric studies, or studies not available in English, or without available complication data. Patient and complication data were extracted from the full text articles. Complication rates were pooled, with results expressed as weighted means and 95 % confidence intervals (CIs). Study heterogeneity was assessed using the I2 statistic.

RESULTS

Across 51 studies including 14,735 patients, no cases of digital ischemia or necrosis were reported.

CONCLUSIONS

Epinephrine use in hand surgery at standard concentrations was not associated with ischemic complications, supporting its safety profile in use in hand surgery. This systematic review shows that epinephrine, when used at standard concentrations, is safe in hand surgery, particularly within the WALANT solution in 1:100,000 concentrations.

CLINICAL RELEVANCE: The use of epinephrine in the hand is safe in hand surgery.