굴곡건 수술에서 각성마취의 유용성

Abstract

Purpose: Although medical texts continue to perpetuate the belief that epinephrine should not be injected in fingers. A comprehensive reviews of articles showing the successful use of local anesthetic with epinephrine in the digits have been presented. Epinephrine mixed lidocaine solution can maintain a bloodless field to be operated. Also epinephrine provides long duration of local anesthetics and makes procedure be performed when patient was wide awake. Methods: From May 2009 to December 2009, total of 10 patients underwent flexor tendon reconstruction with local anesthesia using epinephrine. No tourniquet was necessary. Before operation, all patients were injected local anesthetics using 1 % lidocaine 20ml and 0.1 % epinephrine 0.1ml. Results: There were no cases of digital necrosis or gangrene in the epinephrine injection. All 10 patients actively can bring the finger through a full range of motion. Although procedures were performed with full sterility but without sedation or tourniquet, we could obtain a good operative field and the patients were comfortable. The patient takes his or her fingers through a full range of active motion before the skin is closed. Phentolamine was not required to reverse the vasoconstriction in any patients. Conclusion: The evidence that created the dogma that epinephrine should not be injected into the fingers is clearly not valid. The epinephrine injection has allowed the authors to adjust flexor tendon surgery without the risks associated with general anesthesia. Also It has benefit to get long anesthetic duration, bloodless operative field, and prevents post operative complication. So, in flexor tendon surgery, epinephrine injection will increase indications to be able to operate with local anesthesia.