Optimal Time Delay of Epinephrine in One-Per-Mil Solution to Visualize Operation Field

Prasetyono, Theddeus O.H.; Kusumastuti, Nadia

doi:10.1016/j.jss.2018.11.024

Cited by 9 publications

(8 citation statements)

References 26 publications

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“…Regarding the bloodlessness of the surgical field, there is controversy in the literature about the time interval required between injection and incision. While some authors consider less than 7 min sufficient [ 22 , 23 ], others recommend 13 [ 5 ] or even more than 25 min [ 13 ]. This could be due to different anatomical regions (eyelid versus forearm, neck, oral mucosa/gingiva), different concentrations of epinephrine or LA, too small case numbers as well as fundamentally different study protocols (e.g., close spacing of the injection sites in the eyelid area with result falsification as well as unsuitable drug combinations compared) and measurement methods (spectroscopy versus blood loss measurement).…”

Section: Discussionmentioning

confidence: 99%

“…However, other surgical disciplines such as dermatosurgery or hand surgery also appreciate the advantages of vasoconstrictive additives i.e., increase of local anaesthetic duration, providing haemostasis for surgical procedures and to reduce systemic local anaesthetic blood levels [ 3 , 4 ]. Once developed to prolong anaesthesia, it simultaneously provides ischaemia in the surgical field [ 5 ]. Simultaneously, prolonged vasoconstriction can cause tissue infarction [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Hyperspectral Imaging to Study Dynamic Skin Perfusion after Injection of Articaine-4% with and without Epinephrine—Clinical Implications on Local Vasoconstriction

Thiem¹,

Hans²,

Blatt³

et al. 2021

JCM

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This study aimed to investigate the dynamic skin perfusion via hyperspectral imaging (HSI) after application of Articaine-4% ± epinephrine as well as epinephrine only. After the subcutaneous injection of (A100) Articaine-4% with epinephrine 1:100,000, (A200) Articaine-4% with epinephrine 1:200,000, (Aw/o) Articaine-4% without epinephrine, and (EPI200) epinephrine 1:200,000, into the flexor side of the forearm in a split-arm design, dynamic skin perfusion measurement was performed over 120 min by determining tissue oxygen saturation (StO2) using HSI. After injection, all groups experienced a reactive hyperaemia. With A200, it took about three min for StO2 to drop below baseline. For Aw/o and EPI200, perfusion reduction when compared to baseline was seen at 30 min with vasoconstriction >120 min. A100 caused vasodilation with hyperaemia >60 min. After three minutes, the perfusion pattern differed significantly (p < 0.001) between all groups except Aw/o and EPI200. The vasoactive effect of epinephrine-containing local anaesthetics can be visualised and dynamically quantified via StO2 using HSI. Aw/o + epinephrine 1:100,000 and 1:200,000 leads to perfusion reduction and tissue ischaemia after 30 min, which lasts over 120 min with no significant difference between both formulations. When using Aw/o containing epinephrine in terms of haemostasis for surgical procedures, a prolonged waiting time before incision of 30 or more min can be recommended.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hyperspectral Imaging to Study Dynamic Skin Perfusion after Injection of Articaine-4% with and without Epinephrine—Clinical Implications on Local Vasoconstriction

Thiem¹,

Hans²,

Blatt³

et al. 2021

JCM

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“…This notion was based on our experience in the study of tumescence effect to peripheral perfusion and surgical cases in the clinical setting. 3,10,16 Further studies are needed to prove those hypotheses and to determine how much pressure is required to produce a local anesthesia effect.…”

Section: Discussionmentioning

confidence: 99%

“…This 10-min time delay is deemed sufficient based on previous studies and clinical experiences. 3,16 Fourth, the animal was then removed from its container and placed on a table. Subsequently, it was injected with 20 mL of 5% formalin solution through the plantar surface of its paw using 50-mL Hamilton syringes with 30-G needles (Hamilton Company, Reno, NV) ( Fig.…”

Section: Formalin Testmentioning

confidence: 99%

Experimental Study of Tumescence Injection to Provide Anesthesia Without Local Anesthetics

Biben

Prasetyono

Tantri

2020

Journal of Surgical Research

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“…This interval is imperative in delivering a bloodless operative field, as the efficacy of epinephrine inducing vasoconstriction complies with its optimal time delay. 16 Meanwhile, the injection process itself would take several minutes.…”

Section: Techniquementioning

confidence: 99%

No Tourniquet Technique of Surgery for Macrodactyly

Prasetyono

Santoso

2021

Techniques in Foot &Amp; Ankle Surgery

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The tourniquet technique in limb surgery has traditionally been performed to produce bloodless operative fields. Nevertheless, there are limitations derived from the tourniquet itself; either the complications that may occur because of the ischemic effects, or the constraint of time because of the ischemic time. As no surgeon expects dreadful adverse events in their practices, an alternative technique may fill up the demand. The implementation of epinephrine, which was previously believed to be dangerous, has been performed in end-artery organs such as toes and fingers. In this article, the authors apply the tumescent technique with the use of 1:1,000,000 epinephrine or shortly termed as one-per-mil solution, without using the pneumatic tourniquet. The technique presents relatively clear operative fields, yet safe. Although the risk of bleeding is higher because of the enlarged vascular caliber and all structures around the affected digits, the technique facilitates clear visualization of important structures. In addition, the long action of the one-per-mil tumescent solution notably provides a much longer surgery duration, which facilitates complex surgery for macrodactyly.Level of Evidence: Treatment level of evidence IV-case series. See Instructions for Authors for a complete description of levels of evidence.

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Optimal Time Delay of Epinephrine in One-Per-Mil Solution to Visualize Operation Field

Cited by 9 publications

References 26 publications

Hyperspectral Imaging to Study Dynamic Skin Perfusion after Injection of Articaine-4% with and without Epinephrine—Clinical Implications on Local Vasoconstriction

Hyperspectral Imaging to Study Dynamic Skin Perfusion after Injection of Articaine-4% with and without Epinephrine—Clinical Implications on Local Vasoconstriction

Experimental Study of Tumescence Injection to Provide Anesthesia Without Local Anesthetics

No Tourniquet Technique of Surgery for Macrodactyly

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