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Lidocaine with epinephrine is ubiquitous in hand procedures. Although existing literature supports the overall safety of this, significant physiologic changes accompanying epinephrine can disproportionately affect vascularly compromised patients, such as in Raynaud’s phenomenon. The literature is reviewed and a case presented regarding the dangers...
Context in source publication
Context 1
... was advised to apply heat and noted temporary improvement; however by the next morning she had developed a large bulla at the tip of the finger. She was promptly assessed in the clinic (Figure 1). The finger was warm and well perfused and the decision was made not to inject phentolamine. ...
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Objective
The purpose of this prospective, randomized clinical trial was to evaluate the effect of cooling a 2% lidocaine solution with 1:200,000 epinephrine, administered as a supplementary intraligamentary injection to overcome a failed primary inferior alveolar nerve block (IANB).
Methods
The study was preceded by a pilot study to evaluate the...
Citations
Idiopathic digital infarction, a rare subset of digital infarction, is characterized by ischemic changes in the absence of identifiable underlying etiology. We present the first documented case of idiopathic digital infarction in a 47-year-old female with insignificant medical history. Clinical evaluation revealed bluish discoloration of the left lateral three fingers. Negative findings on autoimmune serologies, echocardiogram, and coagulation profiles excluded common causes, such as vasculitis, cardiac embolism, and hypercoagulable states. Imaging studies demonstrated ischemic changes in the left cerebellar hemisphere and proximal left subclavian artery, which supported the diagnosis of acute infarction. The patient was managed conservatively and was discharged. This case underscores the diagnostic complexities of IDI and highlights the importance of thorough evaluation and management.
The Wide-Awake-Local-Anesthesia-No-Tourniquet (WALANT) technique is being used progressively more and more in hand surgery as it avoids tourniquet-related complications and saves money.
In the present study, we analyzed our cases of carpal tunnel syndrome or trigger finger operated upon with this technique from January 1, 2018 to December 31, 2022.
We obtained 822 cases (426 carpal tunnel syndrome, 396 trigger finger) with an overall anesthesiologic efficacy (no need of additional anesthetic) of 97.8%. Patients were satisfied or very satisfied with the anesthetic choice in 99.8% of cases.
We believe WALANT to be a safe and effective technique that every hand surgeon should have in his/her repertoire.
Cryotherapy is a widely utilized topical treatment for various dermatological conditions. While generally safe and effective, it carries potential risks, such as frostbite injury. Frostbite, a vascular condition causing skin and tissue freezing, is usually associated with prolonged exposure to freezing environments. Certain populations, like military personnel navigating frigid terrains, face an increased risk of frostbite and other cold-weather injuries. In this case, we present an unusual instance of iatrogenic frostbite in a 23-year-old active duty United States Navy Sailor. The patient required a diverse range of treatment modalities, including pain management, sildenafil, nitroglycerine paste, and hyperbaric oxygen therapy. The implemented treatment regimen resulted in significant clinical improvements with minimal long-term structural damage. This case underscores the clinical value of establishing clear management guidelines for cryotherapy administration in cutaneous conditions. Such guidelines are essential to ensure optimal dosing, minimize adverse sequelae, and improve overall prognosis.
