I STRONGLY SUSPECT that the current misconceptions concerning the use of a local anesthetic and epinephrine (Adrenalin) mixture in the hand stem from Bunnell's Surgery of the Hand. It states:
Local anesthesia, especially with adrenalin content, is best avoided as it lowers the resistance of the tissues. Tissues must have maximum vitality. Adrenalin should never be injected into a digit because from this gangrene has often resulted.
The subsequent edition of this book2 has mitigated this arbitrary wording, "If used in a digit it should not contain epinephrine," but two statements are made that contradict one another: "A tourniquet is essential," and then a few pages later, "Protection of and preservation of optimum blood supply is a most important factor in all extremity surgery." I feel that a very useful adjunct to hand surgery has been maligned. And surely because of this attitude, many unnecessary general anesthetics have been
Johnson HA. Infiltration With Epinephrine and Local Anesthetic Mixture in the Hand. JAMA. 1967;200(11):990–991. doi:10.1001/jama.1967.03120240118030
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