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Anesthetics
Anesthetics
Numerous medication options exist for use of local anesthesia. The use of local anesthetics combined with epinephrine has been proven to be safe and effective, providing improved hemostasis and longer duration of anesthesia.1 In the past, classical surgical teaching dictated that epinephrine was to be avoided in the digits due to risk of digital necrosis. These cases were largely presented in case reports and with the use of nonstandard anesthetic formulations. Numerous large studies have demonstrated the safe use of epinephrine in the hand and fingers.2,3 Nonetheless the risk of mechanical
tourniquet caused by anesthetic infiltration should be acknowledged.
Few absolute contraindications exist for the use of the local anesthetic and blocks. Anesthetics do not work well in an acidic environment, reducing their efficacy in cases of infection. Additionally, these blocks can be uncomfortable when placed, making their use in young and uncooperative patients difficult. Caution should also be used in cases of compromised circulation.
A smaller gauge needle (30 gauge) is routinely used in the hand due to the high density of pain fibers. When injecting with small caliber needles, the use of lowervolume syringes (3 mL) decreases the amount of force needed to administer the injection.