Optimal time delay between epinephrine injection and incision to minimize bleeding.

Abstract

BACKGROUND:

The time until maximal cutaneous vasoconstriction after injection of lidocaine with epinephrine is often given in textbooks and multiple choice examinations as 7 to 10 minutes. However, in our experience, there is significantly less cutaneous bleeding if one waits considerably longer than 7 to 10 minutes after injection of local anesthesia with epinephrine for most procedures on human skin.

METHODS:

This was a prospective, randomized, triple-blind study where 12 volunteers were injected simultaneously in each arm with either 1% lidocaine with epinephrine (study group) or 1% plain lidocaine (control group), after which the relative hemoglobin concentration of the underlying skin and soft tissues was measured over time using spectroscopy.

RESULTS:

In the epinephrine group, the mean time at which the lowest cutaneous hemoglobin level was obtained was 25.9 minutes (95 percent CI, 25.9 ± 5.1 minutes). This was significantly longer than the historical literature values of 7 to 10 minutes for maximum vasoconstriction after injection. Mean hemoglobin index values at every time measurement after postinjection minute 1 were significantly different between the study group and the control group, with use of a two-tailed paired t test (p < 0.01).

CONCLUSIONS:

If optimal visualization is desired, the ideal time for the surgeon to begin the incision should be 25 minutes after injection of local anesthetic with epinephrine. It takes considerably longer than 7 to 10 minutes for a new local equilibrium to be obtained in relation to hemoglobin quantity.

• Authors: Daniel E McKee, Donald H Lalonde, Achilleas Thoma, Diana L Glennie, Joseph E Hayward
• Journal: Plastic and reconstructive surgery (Plast Reconstr Surg) Vol. 131 Issue 4 Pg. 811-814 (Apr 2013) ISSN: 1529-4242 [Electronic] United States
• PMID: 23249984 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Vasoconstrictor Agents
• Epinephrine

Topics

• Adult
• Blood Loss, Surgical (prevention & control)
• Double-Blind Method
• Epinephrine (administration & dosage)
• Female
• Humans
• Injections
• Male
• Prospective Studies
• Time Factors
• Vasoconstrictor Agents (administration & dosage)
• Young Adult