Infiltration With Epinephrine and Local Anesthetic Mixture in the Hand

I STRONGLY SUSPECT that the current misconceptions concerning the use of a local anesthetic and epinephrine (Adrenalin) mixture in the hand stem from Bunnell'sSurgery of the Hand. It states: Local anesthesia, especially with adrenalin content, is best avoided as it lowers the resistance of the tissues. Tissues must have maximum vitality. Adrenalin should never be injected into a digit because from this gangrene has often resulted. The subsequent edition of this book²has mitigated this arbitrary wording, "If used in a digit it should not contain epinephrine," but two statements are made that contradict one another: "A tourniquet is essential," and then a few pages later, "Protection of and preservation of optimum blood supply is a most important factor in all extremity surgery." I feel that a very useful adjunct to hand surgery has been maligned. And surely because of this attitude, many unnecessary general anesthetics have been