Current Trends in Use of Epinephrine in Hand Surgery

Epinephrine use during hand surgery has been stigmatized due to a fear of digital necrosis. Clinical experience in the past 2 decades has shown epinephrine in local anesthetic to be safe. We sought to analyze the use of epinephrine among hand surgeons and identify variables associated with it.

A deidentified 21-question survey was distributed via email to the 914 and 415 members of the American Association for Hand Surgery and the Canadian Society for Surgery of the Hand, respectively. Questions included residency type, years of practice, practice setup/ownership, practice leadership, usage of epinephrine, availability of reversal agents, and reasons for or against usage.

Of 188 responders, 170 (90%) used epinephrine in local anesthetic for hand surgery procedures. By nationality, 100% (43) of Canadian surgeons and 89% (108) of US surgeons use epinephrine (P = .01). Among surgeons with practice ownership, 88% (102) used epinephrine compared with 93% (85) of those surgeons that we employed (P = .28). Comparing surgeons with teaching responsibilities versus those without training responsibilities showed that surgeons who did not teach used epinephrine at a higher rate (87% vs 98%, P = .04). In addition, plastic surgery-trained surgeons (111) used epinephrine in 97.2% of cases while orthopedic surgery-trained surgeons (57) used epinephrine in 80.2% of cases (P = .0003). No difference was found when examining the use of epinephrine and surgeon age (P = .28).

Most respondents believe that epinephrine is safe. Training background, location, and practice setup are significant factors in the use of epinephrine, whereas practice ownership and physician age are not major factors.