gms | German Medical Science

Objectives/Interrogation: One of the most significant advance in knowledge about hand anesthesia is based on the safety of local infiltration of epinephrine. It promotes vasoconstriction and combined with lidocaine or ropivacaine eliminates the need for sedation, brachial plexus blocks and general anesthesia for frequent hand surgeries.

The wide-awake anesthetic-surgical technique traditionally described in the literature consists of local administration of lidocaine and epinephrine by the orthopaedic surgeon.

We adapted this technique to our surgical practice, in a teamwork between orthopaedics and anesthesia. Several hand surgical procedures were performed with this protocol. In this paper we describe the procedures and results of 9 patients whose follow up was documented.

Methods: We describe 9 procedures that were evaluated and documented: 5 surgeries of arthrolysis and tenolysis, 3 tendinous section repair and a metacarpal desrotative osteotomy with arthrolysis and tenolysis.

In all cases, the anesthetist performed a distal peripheral block at the level of the radial, ulnar and median nerve, according with the required territory (2-3 mL of ropivacaine at 3.75 mg/mL).

20 minutes after, epinephrine is locally infiltrated in doses up to 15 mL in the palmar region, 2 mL on the 1st and 2nd phalanges and 1 mL on the 3rd phalanx. Surgery starts in 30 minutes.

No tourniquet was used. Patients were fully aware throughout the procedure, moving the concerned segment when requested, allowing tendon tension and excursion assessment, suture strength, release efficacy and movement correction.

Results and Conclusions: Distal block with ropivacaine, in the referred doses, makes an effective sensory blockage for a 12 hours average period, maintaining the motor capacity that allows active mobilization by the patient during the surgical procedure demonstrating the effectiveness of the surgical procedure.

Ropivacaine and epinephrine were effective in pain and hemorrhage control, removing the need for sedation and tourniquet.

Positive results were obtained in hand fractures surgeries, repair and tendon transpositions. It enables the patient to collaborate during the surgery by actively performing the movement that needs to be tested.

Reduces complications of rupture, incomplete tenolysis or joint stiffness by allowing motion monitoring intra-op and early rehabilitation post-op.

Allows a more effective pain control than the traditionally one, since the effect is longer with ropivacaine.