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Epinephrine and the Traumatic Hand in the Emergency Room
Angela T. Prescott, MD
Benjamin K. Schilling, MS
Jignesh V. Unadkat, MD
University of Pittsburgh Medical Center (UPMC)
2020-02-12
Presenter: Angela T. Prescott, MD
Affidavit:
This abstract reflects the original work of this resident.
Director Name: Vu T. Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Hypothesis: We hypothesize that outcomes and complication rates are not statistically different between patients who are treated with lidocaine with epinephrine versus those treated with lidocaine plain.
Methods: With IRB approval, we retrospectively reviewed charts of acute hand trauma patients between July to September 2018 presenting to 2 level 1 trauma centers. 38 patients with 58 injuries met criteria and were stratified into two groups: those treated with 1% lidocaine with epinephrine versus 1% lidocaine plain. Endpoints included infection, need for antibiotics, necrosis, stiffness, and need for re-operation, need for occupational therapy (OT), length of OT, and time to final clinic visit.
Results: Patient demographics, co-morbidities, and mechanism of injury were evenly matched. There was no statistical difference in rates of infection (p=1.0), need for antibiotics (p=0.77), stiffness (p=1.0), necrosis (p=1.0), need for re-operation (p=1.0), need for OT (p=1.0), length of OT (p=0.4), or time to resolution of issue (p=0.5). Post-injury infection was significantly associated with patient comorbidity and mechanism of injury (p=0.007). Need for repeat antibiotics was significantly correlated with patient co-morbidities and smoking status (p=0.003). Stiffness and re-operation rates were related to patient co-morbidities (p=0.002).
Conclusion: Our early data demonstrates that practitioners of hand surgery may continue to use lidocaine with epinephrine in patients with acute traumatic hand injuries without posing further increased risk of post-traumatic complications.
