This dogma in Plastic Surgery should stop, Quick Anaesthesia Tips & New Events

Lemme start…

A prominent dogma in our field involves the use of adrenaline in finger local anaesthesia. Traditionally shunned due to fears of gangrene, this practice is rooted in teachings passed down through generations.

Back in 1903, Heinrich Braun introduced epinephrine into cocaine solutions to extend anaesthesia effects, acting as a 'chemical tourniquet.' Despite its benefits, Braun urged caution, particularly in digits, due to potential risks if the epinephrine action was too intense or prolonged—especially when blood supply was already compromised. This caution dated from a time when adrenaline was manually diluted.

Why the Persistence of this Dogma?

Why does this caution still hold sway? It stems from a medical culture that prioritises "do no harm," leading us to opt for what seems safest—typically plain lidocaine or bupivacaine—due to historical concerns.

Textbook influence is also profound. Titles like 'Green's Operative Hand Surgery' have consistently cautioned against using epinephrine in digital blocks, reinforcing this cautious approach for decades.

What does the evidence say?

PlasticsFella Twitter polls show that over 75% of practitioners now safely use adrenaline in finger procedures, with no complications reported, challenging these fears. Historical data from a 1967 study with 421 cases using lidocaine and epinephrine, which reported zero digital gangrene incidents, supports this shift.

Moreover, the 2005 Dalhousie Project by Donald Lalonde, which documented adrenaline's safe use in thousands of cases without any finger infarction or tissue loss, further confirms its safety in controlled settings, questioning traditional prohibitions.

As we reassess medical dogmas, I encourage you to share: What's your biggest dogma in plastic surgery? Post your thoughts below, and let's explore these topics in this week's edition of Behind the 'Fella.