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Hand hygiene01:23

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Asepsis is the practice of preventing or breaking the chain of infection. The nurse employs aseptic techniques to prevent the spread of microorganisms and reduce the risk of diseases. Hand hygiene is the cornerstone of aseptic techniques and is classified into medical and surgical asepsis. Medical asepsis includes hand hygiene and the use of gloves. Surgical asepsis, or the sterile technique, refers to practices that render and keep objects and areas free of microorganisms.
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Endoscopic Cholesteatoma Surgery
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Epinephrine and hand surgery.

Calista Stevens1, Kelly White1, Eve Cathcart1

  • 1University of Connecticut School of Medicine, Farmington, CT, USA.

Journal of Hand and Microsurgery
|February 12, 2026
PubMed
Summary
This summary is machine-generated.

Epinephrine use in hand surgery, including the Wide Awake Local Anesthesia with No Tourniquet (WALANT) technique, is safe. A systematic review found no digital ischemia or necrosis complications in 14,735 patients.

Keywords:
EpinephrineHand surgeryIschemiaLidocaineWALANT

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Area of Science:

  • Hand Surgery
  • Anesthesiology
  • Vascular Surgery

Background:

  • Growing emphasis on value-based care and Wide Awake Local Anesthesia with No Tourniquet (WALANT) technique increase epinephrine use in hand surgery.
  • Surgeons express concerns regarding elective epinephrine use in the finger despite its perceived safety.
  • Need for evidence-based data to inform surgeons and patients about epinephrine's safety in hand surgery.

Purpose of the Study:

  • To systematically review the rate of ischemic complications associated with epinephrine use in hand surgery.
  • To evaluate the safety of epinephrine in hand surgery, particularly within the WALANT technique.
  • To provide data supporting or refuting concerns about digital ischemia from epinephrine use.

Main Methods:

  • Systematic search of the Scopus database (2005-2022).
  • Inclusion of 51 studies with 14,735 patients undergoing hand surgery with epinephrine injection (carpus and distal).
  • Exclusion of case reports, reviews, animal/cadaveric studies, non-English, or studies lacking complication data; pooled analysis of complication rates.

Main Results:

  • No cases of digital ischemia or necrosis were reported across 51 studies.
  • A total of 14,735 patients were included in the systematic review.
  • Epinephrine use at standard concentrations showed no association with ischemic complications.

Conclusions:

  • Epinephrine use in hand surgery at standard concentrations is safe and not associated with ischemic complications.
  • The findings support the safety profile of epinephrine, especially within the WALANT technique at 1:100,000 concentrations.
  • This systematic review provides robust evidence for the safe use of epinephrine in hand surgery.