Epinephrine one-per-mil tumescent solution in hand surgery: Review of experimental and clinical studies

T O H Prasetyono

doi:10.1016/j.hansur.2021.04.013

Epinephrine one-per-mil tumescent solution in hand surgery: Review of experimental and clinical studies

Hand Surg Rehabil. 2021 Oct;40(5):554-559. doi: 10.1016/j.hansur.2021.04.013. Epub 2021 May 14.

Author

T O H Prasetyono¹

Affiliation

¹ Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital/Faculty of Medicine Universitas Indonesia, Jl. Diponegoro No. 71, Jakarta 10430, Indonesia; ICTEC (Indonesian Clinical Training and Education Center), Cipto Mangunkusumo Hospital/Faculty of Medicine Universitas Indonesia, Jl. Diponegoro No. 71, Jakarta 10430, Indonesia; Medical Technology Cluster, IMERI (Indonesian Medical Education and Research Institute), Faculty of Medicine Universitas Indonesia, Education Tower, 2nd Floor, Jl. Salemba Raya No. 6, Jakarta, Indonesia. Electronic address: theddeus.h@ui.ac.id.

PMID: 33992818
DOI: 10.1016/j.hansur.2021.04.013

Abstract

One-per-mil epinephrine solution (1:1,000,000) injected as a tumescent has been used in several hand and upper-limb surgery cases as a substitute for tourniquet. However, reviews of its effectiveness are still lacking. A comprehensive review was conducted based on PubMed, Scopus, Science Direct, Cochrane Library, and Semantic Scholar database search of relevant studies using the keyword "one-per-mil." Studies not using the exact one-per-mil tumescent solution formula were excluded. The review of clinical studies was conducted according to PRISMA guidelines. Epinephrine and the hydrostatic vasocompressive effect created bloodless operative fields, with 100% experimental flap survival after ischemic insult. The technique was effective in creating bloodless operative fields in 36.3% of varied hand and upper-limb surgery cases and in fully awake surgery. Current studies show that one-per-mil tumescent solution is safe and effective, enabling use of tourniquet to be avoided.

Keywords: Anesthésie locale; Blessures à la main; Epinephrine; Epinéphrine; Hand injury; Lidocaine; Lidocaïne; Local anesthesia; Vigilance; Wakefulness.