Wilhelmi B J, Blackwell S J, Miller J H, Mancoll J S, Dardano T, Tran A, Phillips L G
Division of Plastic Surgery, University of Texas Medical Branch, Galveston, 77555-0724, USA.
Plast Reconstr Surg. 2001 Feb;107(2):393-7. doi: 10.1097/00006534-200102000-00014.
The purpose of this study was to examine the role for epinephrine augmentation of digital block anesthesia by safely prolonging its duration of action and providing a temporary hemostatic effect. After obtaining approval from the review board of the authors' institution, 60 digital block procedures were performed in a prospective randomized double-blinded study. The digital blocks were performed using the dorsal approach. All anesthetics were delivered to treat either posttraumatic injuries or elective conditions. Of the 60 digital block procedures, 31 were randomized to lidocaine with epinephrine and 29 to plain lidocaine. Of the procedures performed using lidocaine with epinephrine, one patient required an additional injection versus five of the patients who were given plain lidocaine (p = 0.098). The need for control of bleeding required digital tourniquet use in 20 of 29 block procedures with plain lidocaine and in 9 of 31 procedures using lidocaine with epinephrine (p < 0.002). Two patients experienced complications after plain lidocaine blocks, while no complications occurred after lidocaine with epinephrine blocks (p = 0.23). By prolonging lidocaine's duration of action, epinephrine may prevent the need for an additional injection and prolong post-procedure pain relief. This study demonstrated that the temporary hemostatic effect of epinephrine decreased the need for, and thus the potential risk of, using a digital tourniquet (p < 0.002). As the temporary vasoconstrictor effect is reversible, the threat of complication from vasoconstrictor-induced ischemia is theoretical.
本研究的目的是通过安全延长其作用时间并提供临时止血效果来检验肾上腺素增强指神经阻滞麻醉的作用。在获得作者所在机构审查委员会的批准后，在一项前瞻性随机双盲研究中进行了60例指神经阻滞手术。指神经阻滞采用背侧入路进行。所有麻醉剂均用于治疗创伤后损伤或择期疾病。在60例指神经阻滞手术中，31例随机接受利多卡因加肾上腺素，29例接受单纯利多卡因。在使用利多卡因加肾上腺素进行的手术中，1例患者需要额外注射，而接受单纯利多卡因的患者中有5例需要额外注射（p = 0.098）。在29例使用单纯利多卡因的阻滞手术中有20例需要使用手指止血带控制出血，而在31例使用利多卡因加肾上腺素的手术中有9例需要使用手指止血带控制出血（p < 0.002）。2例患者在接受单纯利多卡因阻滞后出现并发症，而在接受利多卡因加肾上腺素阻滞后未出现并发症（p = 0.23）。通过延长利多卡因的作用时间，肾上腺素可能避免额外注射的需要并延长术后疼痛缓解时间。本研究表明，肾上腺素的临时止血效果降低了使用手指止血带的必要性，从而降低了潜在风险（p < 0.002）。由于临时血管收缩作用是可逆的，血管收缩剂引起的缺血导致并发症的威胁只是理论上的。
