Author:
Moog P.,Dozan M.,Betzl J.,Sukhova I.,Kükrek H.,Megerle K.
Abstract
AbstractIntroductionAlthough the WALANT technique’s long-term safeness has been demonstrated in many studies, there are only few data investigating its short-term effects on tissue perfusion and oxygen levels. It was hypothesized that, temporarily, critical levels of tissue perfusion may occur.MethodsSeventeen patients, who were scheduled for different procedures in WALANT technique, were injected with 5–7 ml of 1% Articain containing 1:200,000 epinephrine at the finger base. Capillary-venous oxygen saturation, hemoglobin volume in the capillaries, and relative blood flow in the fingertips were recorded once per second by white light spectrometry and laser Doppler flowmetry before, during and after injection for an average of 32 min.ResultsClinically, no persistent tissue malperfusion was observed, and there were no postoperative complications. Capillary-venous oxygen saturation was reduced by ≥ 30% in seven patients. Critical levels of oxygen saturation were detected in four patients during 13 intervals, each lasting for 132.5 s on average. Oxygen saturation returned to noncritical values in all patients by the end of the observation period. Blood flow in the fingertips was reduced by more than 30% in nine patients, but no critical levels were observed, as with the hemoglobin. Three patients demonstrated a reactive increase in blood flow of more than 30% after injection.ConclusionsInjection of tumescent local anesthesia containing epinephrine into finger base may temporarily cause a substantial reduction in blood flow and lead to critical levels of oxygen saturation in the fingertips. However, this was fully reversible within minutes and does not cause long-term complications.
Publisher
Springer Science and Business Media LLC
Subject
Orthopedics and Sports Medicine,General Medicine,Surgery,Surgery
Reference29 articles.
1. Lalonde D, Martin A (2014) Tumescent local anesthesia for hand surgery: improved results, cost effectiveness, and wide-awake patient satisfaction. Arch Plastic Surg 41(4):312
2. Lalonde DH (2017) Conceptual origins, current practice, and views of wide awake hand surgery. J Hand Surg (European Volume) 42(9):886–895
3. Thomson CJ, Lalonde DH, Denkler KA, Feicht AJ (2007) A critical look at the evidence for and against elective epinephrine use in the finger. Plast Reconstr Surg 119(1):260–266
4. Lalonde D (2015) Wide awake local anaesthesia no tourniquet technique (WALANT). BMC proceeding. Springer, Berlin
5. Altinyazar HC, Özdemir H, Koca R, Hoşnuter M, Demirel CB, Gündoğdu S (2004) Epinephrine in digital block: color Doppler flow imaging. Dermatol Surg 30(4):508–511
Cited by
12 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献