title: One-per-mil tumescent technique for bone and joint surgery in hand.
abstract: BACKGROUND
  This study aims to explore the effectiveness of one-per-mil tumescent technique in hand surgery, which involves bone and joint.
  
  
  METHODS
  This is a case series study on 14 patients with 15 operative fields. One-per-mil solution is formulated by mixing 0.05 mL of 1:1,000 epinephrine and 100 mg lidocaine in 50-mL saline solution. The solution was injected subcutaneously into the operative area until the skin turned pale. The surgery started 7-10 min after the last injection. We classified the operative field clarity into four categories: totally bloodless, minimum bleeding, acceptable bleeding, and bloody operative field. We also recorded the amount of tumescent solution, top-ups needed, length of surgery, type of anesthesia, and intraoperative pain reported by the patients under local anesthesia.
  
  
  RESULTS
  Five patients were operated on under local anesthesia while the other ten were under general anesthesia. Eight cases yielded totally bloodless operative fields, while seven were classified as acceptable bleeding. There were no top-ups and conversion of anesthesia needed during surgery.
  
  
  CONCLUSIONS
  We consider one-per-mil tumescent technique as a promising successor of pneumatic tourniquet in bone and joint surgery, especially for lengthy procedures on hand and upper extremity.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, University of Indonesia-Cipto Mangunkusumo Hospital, Medical Staff Building, 4th floor, Jl. Diponegoro 71, Jakarta, 13410 Indonesia.
authors.forename: Theddeus O H
authors.initials: TO
authors.lastname: Prasetyono
authors.affiliation: Jl. Diponegoro 71, Jakarta, 13410 Indonesia.
authors.forename: Debby K A
authors.initials: DK
authors.lastname: Saputra
authors.affiliation: Jl. Diponegoro 71, Jakarta, 13410 Indonesia.
authors.forename: Windi
authors.initials: W
authors.lastname: Astriana
keywords: Bone; Epinephrine; Fractures; Hand bones; Lidocaine; Tourniquets