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Related Concept Videos

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

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Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
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Local Anesthetics: Pharmacokinetics01:13

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The potency and duration of action of local anesthetics (LAs) are determined by their pharmacokinetics. Pharmacokinetics describes how LAs are absorbed, distributed, metabolized, and eliminated from the body. When administered to the vascular tissues, LAs are quickly absorbed and enter the systemic circulation, reducing their localized effects. Adding vasoconstrictors such as epinephrine to LAs reduces their absorption into the systemic circulation, making them clinically effective. The...
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Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

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Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
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Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia01:30

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Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...
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Local Anesthetics: Common Agents and Their Applications01:23

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Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...
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Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
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Tourniquet Use for Short Hand Surgery Procedures Done Under Local Anesthesia Without Epinephrine.

Brandon S Shulman1, Michael Rettig1, S Steven Yang1

  • 1Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY.

The Journal of Hand Surgery
|January 12, 2020
PubMed
Summary

Short hand surgeries using local anesthesia with a tourniquet (LA-T) are feasible and well-tolerated. Patients reported LA-T as a favorable alternative when epinephrine injections are not possible, with anesthetic injection being more painful than tourniquet use.

Keywords:
Hand surgeryWALANTlocal anesthesiatourniquetwide awake

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Area of Science:

  • Orthopedic Surgery
  • Hand Surgery
  • Anesthesiology

Background:

  • Wide-awake local anesthesia no tourniquet (WALANT) is a popular technique.
  • Pre-procedure epinephrine injections may not always be feasible due to logistical or patient-specific factors.
  • Alternative hemostasis methods are needed for wide-awake hand surgery.

Purpose of the Study:

  • To evaluate pain and patient experience with short hand surgeries using local anesthesia and a tourniquet (LA-T).
  • To compare pain associated with local anesthetic injection versus tourniquet use.
  • To assess the feasibility and acceptance of LA-T as an alternative to epinephrine.

Main Methods:

  • Ninety-six patients undergoing short hand procedures with LA-T were assessed.
  • Pain was measured using a visual analog scale (VAS).
  • Patient experience was evaluated using a questionnaire, and tourniquet times were recorded.

Main Results:

  • Mean pain from anesthetic injection was 3.9/10; mean tourniquet pain was 2.3-2.9/10.
  • 99% of patients would opt for LA-T again.
  • Tourniquet times under 10 minutes were associated with less pain than longer durations.

Conclusions:

  • Short wide-awake procedures using LA-T are feasible and well-accepted.
  • Local anesthetic injection pain exceeded tourniquet pain.
  • LA-T is a viable option when pre-procedure epinephrine is logistically challenging.