Epinephrine effect on surgical wound healing

[Timeoutofmind]

---

Members do not see this ad.

Hi all:

I am looking for research regarding whether adding epi to lido effects wound healing.

I know it is common surgical practice for hemostasis, but I was just curious if it had been studied.

Thanks in advance.

 

[HighPriest]

whatever you do, don't inject it into fingertips or noses or ears. They fall off every time.

 

[LucidSplash]

If only there was a website where you could search medical literature on any topic...

 

[DoctwoB]

whatever you do, don't inject it into fingertips or noses or ears. They fall off every time.

Don’t forget penises. It’s not like they have a robust redundant vascular supply. Falls right off.

 

[HighPriest]

To be fair, I actually don’t want anything injected into my penis.

 

[vhawk]

To be fair, I actually don’t want anything injected into my penis.

topical only

 

[Psai]

To be fair, I actually don’t want anything injected into my penis.

Life is short, live a little

 

[XCdude]

everything that has been said above is false. I use epi all the time for hand/finger/nose/ear repairs. In fact, with the rise of WALANT the hand society has acknowledged this a fallacy. I am willing to bet a little epi in a phallus would cause no untoward effects either but I am not a urologist.

 

[VA Hopeful Dr]

everything that has been said above is false. I use epi all the time for hand/finger/nose/ear repairs. In fact, with the rise of WALANT the hand society has acknowledged this a fallacy. I am willing to bet a little epi in a phallus would cause no untoward effects either but I am not a urologist.

99% sure they were being sarcastic

 

[HighPriest]

99% sure they were being sarcastic

You can be more sure than that.

 

[LucidSplash]

everything that has been said above is false. I use epi all the time for hand/finger/nose/ear repairs. In fact, with the rise of WALANT the hand society has acknowledged this a fallacy. I am willing to bet a little epi in a phallus would cause no untoward effects either but I am not a urologist.

You must be a lot of fun at parties.

 

[Apollyon]

99% sure they were being sarcastic

100%.

 

[mestielest]

Don’t forget penises. It’s not like they have a robust redundant vascular supply. Falls right off.

everything that has been said above is false. I use epi all the time for hand/finger/nose/ear repairs. In fact, with the rise of WALANT the hand society has acknowledged this a fallacy. I am willing to bet a little epi in a phallus would cause no untoward effects either but I am not a urologist.

Usage of epinephrine containing solutions is declared to be contrindicated in the major urology textbooks, such as Hinman's or Campbell's. The product informations of the available preparations (for example Jetokain or Lidofast) also contrindicate using them in the penile surgery.

However the reality is completely different. Epi-Lido is probably the most commonly used local anesthetic in circumcision. I have carried out more than 1000 circumcisions using Epi-Lido. I know circumcision series > 100.000 using Jetokain without any necrosis or ischemia. I think the contrindication is completely obsolete. However, using correct dosage and injecting in the correct plane are mandatory.

 

[HighPriest]

We know, bro. We all do it. I inject every single nose on which I operate with epinephrine. Every time.

 

[LucidSplash]

We aren’t all idiots. We’re mostly just sarcastic jerks.

 

[HighPriest]

I usually don't inject the penis, however. For three reasons:
1 - Ouch
2 - The insignificant chance that it will turn necrotic and fall off
3 - lawsuits. hard to explain why I did that.

 

[evilbooyaa]

I usually don't inject the penis, however. For three reasons:
1 - Ouch
2 - The insignificant chance that it will turn necrotic and fall off
3 - lawsuits. hard to explain why I did that.

Might have a hard time justifying why you're so far from the E, the N, and the T when you stab a patient's penis.

 

[Apollyon]

Might have a hard time justifying why you're so far from the E, the N, and the T when you stab a patient's penis.

The D and B?

 

[HighPriest]

Might have a hard time justifying why you're so far from the E, the N, and the T when you stab a patient's penis.

Definitely not ENT&A, that's for sure. And dealing with one D&B is more than enough.

 

[VA Hopeful Dr]

Might have a hard time justifying why you're so far from the E, the N, and the T when you stab a patient's penis.

Its called holistic medicine

 

[mestielest]

Well it's clear that the epinephrine containing preparations have been used millions of procedures worldwide. How much cases do we need to have some "leader of the field" declare that the epinephrine containing local anaesthesia is safe, or at least it is not contrindicated? What do you think about that?

 

[mestielest]

We aren’t all idiots. We’re mostly just sarcastic jerks.

on being an idiot: maybe I'm the only one 🙂
on being a sarcastic jerk: I'm also one. However, I'm not only as I suppose 😀

 

[HighPriest]

Epi in the distal bits will continue being a nonsense taboo, probably forever. Unfortunately, most people learn very early that you shouldn’t inject, and then they never enter a field where they might need to do it. So most of the medical community just never has to learn that it’s safe. I always find it hilarious because they’ll come back with some argument about how hand surgery is done under tourniquet, and I think to myself “yeah, so what are you worried about with a little epi?”

It’s like using ear drops in a patient with a perforated eardrum. More than half the time I put tubes in kids, they come back from their PCP with a draining ear and a note saying they didn’t want to use topical drops because of the tube. Dude....that’s why I placed the tube...but in their defense, even Uptodate has bad information about it. (I realize that example won’t mean anything to anyone who’s not in ENT, but it’s the same concept)

 

[mestielest]

Epi in the distal bits will continue being a nonsense taboo, probably forever. Unfortunately, most people learn very early that you shouldn’t inject, and then they never enter a field where they might need to do it. So most of the medical community just never has to learn that it’s safe. I always find it hilarious because they’ll come back with some argument about how hand surgery is done under tourniquet, and I think to myself “yeah, so what are you worried about with a little epi?”

It’s like using ear drops in a patient with a perforated eardrum. More than half the time I put tubes in kids, they come back from their PCP with a draining ear and a note saying they didn’t want to use topical drops because of the tube. Dude....that’s why I placed the tube...but in their defense, even Uptodate has bad information about it. (I realize that example won’t mean anything to anyone who’s not in ENT, but it’s the same concept)

There is absolutely some "scientific misbeliefs" in the literature. Also for hipospadias surgery we use a tourniquet and dilute epinephrine washing. But for circumcision, it's contrindicated 😵

 

[OtoHNS]

I once injected my right ear with epinephrine and it turned black and fell off.

Then, I painted a self portrait:

 

[VA Hopeful Dr]

Epi in the distal bits will continue being a nonsense taboo, probably forever. Unfortunately, most people learn very early that you shouldn’t inject, and then they never enter a field where they might need to do it. So most of the medical community just never has to learn that it’s safe. I always find it hilarious because they’ll come back with some argument about how hand surgery is done under tourniquet, and I think to myself “yeah, so what are you worried about with a little epi?”

It’s like using ear drops in a patient with a perforated eardrum. More than half the time I put tubes in kids, they come back from their PCP with a draining ear and a note saying they didn’t want to use topical drops because of the tube. Dude....that’s why I placed the tube...but in their defense, even Uptodate has bad information about it. (I realize that example won’t mean anything to anyone who’s not in ENT, but it’s the same concept)

I was taught that as long as you avoid gent containing drops you were fine, but I am on the younger side of things so that might be the difference.

 

[HighPriest]

There is absolutely some "scientific misbeliefs" on the literature. Also for hipospadias surgery we use a tourniquet and dilute epinephrine washing. But for circumcision, it's contrindicated 😵

The covenant with god forbids epinephrine.

I once injected my right ear with epinephrine and it turned black and fell off.

Then, I painted a self portrait:

The things you do for chicks.

 

[HighPriest]

I was taught that as long as you avoid gent containing drops you were fine, but I am on the younger side of things so that might be the difference.

Yeah, you shouldn't use gent. That being said, the closest you'll get to that is neomycin in commercially available otic drops, and there's some literature showing that to be safe.

There's a great workaround: use quinolone drops. Floxin, Ciprodex, Cipro-HC, etc. Then you're safe.

The issue is that there's a lot of very, very bad information that says that using steroids in the middle ear is ototoxic. It isn't.

 

[VA Hopeful Dr]

Yeah, you shouldn't use gent. That being said, the closest you'll get to that is neomycin in commercially available otic drops, and there's some literature showing that to be safe.

There's a great workaround: use quinolone drops. Floxin, Ciprodex, Cipro-HC, etc. Then you're safe.

The issue is that there's a lot of very, very bad information that says that using steroids in the middle ear is ototoxic. It isn't.

Looking back, this is the only thing I definitely remember from my residency ENT rotation so I guess that's something. Though I'll stay away from neomycin anyway since as you say its not like we're lacking for options here.

 

[HighPriest]

Thanks to OP by the way for generating a thread that was in no way used to answer his question.

 

[mestielest]

Thanks to OP by the way for generating a thread that was in no way used to answer his question.

 

[mestielest]

Returning to the main idea:

Effect of subcutaneous epinephrine/saline/local anesthetic versus saline-only injection on split-thickness skin graft donor site perfusion, healing... - PubMed - NCBI
Effects of lidocaine with epinephrine or with buffer on wound healing in rat skin. - PubMed - NCBI
'Plain lignocaine' vs 'Lignocaine with vasoconstrictor'-Comparative evaluation of pain during administration and post-extraction wound healing by a... - PubMed - NCBI
Crosstalk between adrenergic and toll-like receptors in human mesenchymal stem cells and keratinocytes: a recipe for impaired wound healing. - PubMed - NCBI

 

[LucidSplash]

Returning to the main idea:

Effect of subcutaneous epinephrine/saline/local anesthetic versus saline-only injection on split-thickness skin graft donor site perfusion, healing... - PubMed - NCBI
Effects of lidocaine with epinephrine or with buffer on wound healing in rat skin. - PubMed - NCBI
'Plain lignocaine' vs 'Lignocaine with vasoconstrictor'-Comparative evaluation of pain during administration and post-extraction wound healing by a... - PubMed - NCBI
Crosstalk between adrenergic and toll-like receptors in human mesenchymal stem cells and keratinocytes: a recipe for impaired wound healing. - PubMed - NCBI

Oh look at that, you found the website.

OP is also participating in a thread about this in the Pain forum. Many people there also appear to know how to use Pubmed for him.

 

[mestielest]

Oh look at that, you found the website.

OP is also participating in a thread about this in the Pain forum. Many people there also appear to know how to use Pubmed for him.

So...


I did it

 

[Timeoutofmind]

Oh look at that, you found the website.

OP is also participating in a thread about this in the Pain forum. Many people there also appear to know how to use Pubmed for him.

The discussion came up on the pain forum and my personal review of the literature proved somewhat mixed

I posted the discussion among surgeons as I thought I might get some idea as to the body of clinical experience/dogma/consensus statements from organizations out there among the various surgical subspecialties. Probably should have worded the question differently

Thanks for your input everyone and regards.

 

[_Rod_of_Asclepius_]

whatever you do, don't inject it into fingertips or noses or ears. They fall off every time.

“Toes, ears, fingers, nose and anything that grows (penis)” is the mnemonic I heard

 

[LucidSplash]

“Toes, ears, fingers, nose and anything that grows (penis)” is the mnemonic I heard

Yes but the point is that all of that is false dogma. High Priest was being facetious.