One-Per-Mil Tumescent Technique for Bone and Joint Surgery in Hand

Prasetyono, Theddeus O.H.; Saputra, Debby K.A.; Astriana, Windi

doi:10.1007/s11552-014-9661-7

Cited by 5 publications

(7 citation statements)

References 16 publications

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“…As for the DOA of 0.2% lidocaine in a one-per-mil tumescent solution based on the pain test using SW monofilament, we found a result of 186.83±44.02 minutes. Interestingly, Prasetyono et al [ 14 ], who performed surgeries using the same one-per-mil tumescent solution as a local anesthetic agent, revealed successful procedure completion of up to 270 minutes. Even though the DOA of 2% lidocaine mixed with a 1:100,000 concentration of epinephrine in the study by Thomson and Lalonde [ 2 ] was 10.4 hours, the results came as reports by the subjects who were given "digital tumescent block" anesthesia without experienced-pain testing, as we have explained previously.…”

Section: Discussionmentioning

confidence: 99%

“…Further reports have shown the effectiveness of a one-per-mil tumescent solution in facilitating hand surgery without a tourniquet. Interestingly, these reports have also shown the ability of 0.2% lidocaine (in a 1:1,000,000 epinephrine solution) to provide adequate anesthetic effect in hand surgery under local anesthesia [ 6 14 ]. However, the onset and DOA of 0.2% lidocaine with 1:1,000,000 epinephrine has not been reported with confidence.…”

Section: Introductionmentioning

confidence: 99%

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The Onset and Duration of Action of 0.2% Lidocaine in a One-per-Mil Tumescent Solution for Hand Surgery

Prasetyono

Lestari

2016

Arch Plast Surg

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BackgroundOne-per-mil tumescent solution, which contains 0.2% lidocaine with 1:1,000,000 epinephrine, has been reported to be clinically effective for hand surgery under local anesthesia. However, it was lacking in its basic pharmacokinetics profile in regard to the onset of action (OOA) and duration of action (DOA).MethodsA randomized, double-blind study was conducted on 12 volunteers who met the inclusion criteria from October to November 2014. All volunteers had their right and left ring finger pulps injected with either one-per-mil solution or 2% lidocaine. Semmes-Weinstein and two-point discrimination tests were used to test sensation. Visual analogue scale was recorded at the time when the finger lost its sensation and when it regained normal sensation to measure the OOA and DOA. The data were then analyzed with a paired t-test and a Wilcoxon signed-rank test.ResultsThe OOA and DOA of 2% plain lidocaine were 1 minute and 99.67 minutes, respectively. Meanwhile, 0.2% lidocaine in a one-per-mil tumescent solution showed an OOA of 5 minutes and a DOA of 186.83 minutes. The OOA of 0.2% lidocaine in a one-per-mil tumescent solution is statistically shorter than 2% plain lidocaine (P=0.04); while its DOA is statistically longer than 2% plain lidocaine (P<0.001).ConclusionsThe 0.2% lidocaine in a one-per-mil tumescent solution is statistically and clinically superior to 2% plain lidocaine in achieving longer duration of local anesthesia.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Onset and Duration of Action of 0.2% Lidocaine in a One-per-Mil Tumescent Solution for Hand Surgery

Prasetyono

Lestari

2016

Arch Plast Surg

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“…Although this study did not intend to delineate the action of lidocaine, we did not change the content of 1-per-mil formula that had been used previously in the clinical setting of hand surgery. 7,8 The original formula is observed as a whole entity, regardless of any possible potentiation between epinephrine and lidocaine. Nonetheless, to the best of our knowledge, there is no evidence proving lidocaine to either potentiate or inhibit epinephrine.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5] Through various epinephrine concentrations, ranging from 1:100,000 to as low as 1:1,000,000, tumescent solution has shown to have effective haemostatic effect in hand and upper extremity surgery. 2,3,[6][7][8] Prasetyono, who uses 1-per-mil tumescent solution, showed the effectiveness of the technique in creating safe bloodless operative field in his reports. [6][7][8] He has broadened the indications of the technique to be used in hand and upper extremity surgery, including perforator flaps.…”

mentioning

confidence: 99%

“…2,3,[6][7][8] Prasetyono, who uses 1-per-mil tumescent solution, showed the effectiveness of the technique in creating safe bloodless operative field in his reports. [6][7][8] He has broadened the indications of the technique to be used in hand and upper extremity surgery, including perforator flaps. 7 However, in his early cases with flaps, he experienced both complete and partial flap loss.…”

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confidence: 99%

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Systematic Injection Patterned-Technique of One-Per-Mil Tumescent Solution for Perforator-Based Skin Flap: Is it Better Than the Random Patterned-Technique?

Prasetyono

Pribadi

2015

International Surgery

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The aim of the study is to compare the systematic injection patterned-technique of 1-permil tumescent solution versus the random patterned-technique. Several incidences of perforator flap necrosis have been encountered with tumescent technique. Among the possible causes, the most probable cause is the injury of perforator artery due to the multipassing needle injections. Thus, an evaluation regarding the needle injection pattern needs to be done in order to avoid necrotic flap incidence. A randomized controlled experimental study was conducted on both groins of 20 healthy Wistar stained-Rattus novergicus weighing 220 to 270 g. A comparison of a systematic injection pattern and a random injection pattern was performed. Three mL of 1-per-mil tumescent solution was injected subcutaneously before elevation of the islanded groin flap. Clarity of the operative field along with the size of the pedicle were recorded. The photos of survival area of the skin flap on postoperative day 7 were analyzed using Analyzing Digital Images. Totally bloodless operative field was observed in all subjects. Three out of 19 flaps in group A (15.78%) and 4 out of 18 flaps in group B (22.22%), were found to be necrotic, either total or partial. No significant difference (P. 0.05) was found between the injection technique groups, in terms of flap necrosis. Although the 1-per-mil tumescent technique is advantageous in a way that it provides a totally bloodless operative field, the systematic injection patterned-technique was not found to be more superior compared to the custom random patterned-multi-passing needle injection technique.

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A randomized controlled trial: Comparison of one-per-mil tumescent technique and tourniquet in surgery for burn hand contracture in creating clear operative field and assessment of functional outcome

Prasetyono

Sadikin

2022

Burns

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One-Per-Mil Tumescent Technique for Bone and Joint Surgery in Hand

Abstract: 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.

Cited by 5 publications

References 16 publications

The Onset and Duration of Action of 0.2% Lidocaine in a One-per-Mil Tumescent Solution for Hand Surgery

The Onset and Duration of Action of 0.2% Lidocaine in a One-per-Mil Tumescent Solution for Hand Surgery

Systematic Injection Patterned-Technique of One-Per-Mil Tumescent Solution for Perforator-Based Skin Flap: Is it Better Than the Random Patterned-Technique?

A randomized controlled trial: Comparison of one-per-mil tumescent technique and tourniquet in surgery for burn hand contracture in creating clear operative field and assessment of functional outcome

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