title: [Time to bury the adrenaline-myth!--Safe use of adrenaline anesthesia in hand surgery and orthopedics].
abstract: The epinephrine myth originated in the 1940s, when acidic (pH 1) procaine-epinephrine was injected into fingers, causing finger necrosis. Today, level 1 evidence exists for the safe use of epinephrine in fingers. The ability to use lidocaine-epinephrine in hand surgery and orthopedics eliminates the need for a tourniquet, or "bloodless field". Surgery using Wide Awake, Lidocaine-epinephrine Anesthesia, No Tourniquet (WALANT) reduces patient discomfort, facilitates patient participation in surgery, improves safe outcomes following reconstructions and greatly reduces the cost of medical care. Furthermore, patients regarded as high-risk can be safely treated without risk of cardiac or pulmonary side effects. In this manuscript, the background of the epinephrine myth is described, as well as recommended use of WALANT in hand surgery and orthopedics.
authors: Hand & Foot Surgery Center - Stockholm, Sweden Karolinska Institutet - Dept of Clinical Science and Education Stockholm, Sweden.
authors: Elisabet
authors: E
authors: Hagert
authors: Dalhousie University - Dept of Plastic Surgery Saint John, Canada Dalhousie University - Dept of Plastic Surgery Saint John, Canada.
authors: Donald
authors: D
authors: Lalonde
mesh_terms: D000772:Anesthesia, Local / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005385:Fingers / Q000601:surgery; D006225:Hand / Q000601:surgery*; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009229:Mythology
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D004837:Epinephrine