Transient Tourniquet and Electro-cauterization applied for Surgery in Metacarpal Fractures Under Local Anesthesia with Epinephrine

Abstract Background : The purpose of this study is to illustrate whether the electro-cauterization and transient tourniquet enhanced efficiency of local anesthesia with epinephrine in surgery of metacarpal fractures. Methods : Forty-four consecutive cases of metacarpal fractures with estimated major operative time more than 30 minutes were enrolled. Local anesthesia with epinephrine, electro-cauterization and transient tourniquet were performed. Data regarding anesthesia effect, bleeding in the surgical field (with inflating and deflating tourniquet), time when patient felt uncomfortable with tourniquet, inspection of the surgical outcome, and some other surgical tricks were collected and evaluated. Results : All patients felt no pain for whole surgical period in the surgical field. Time when patient felt uncomfortable with tourniquet was about 16 minutes. Mean tourniquet time was about 29 minutes. There was no or less bleeding in the surgical field for whole surgical period. The anatomical structures, such as nerve, tendon and vessel can be easily distinguished and dissected. Outcome of repair and reconstruction could be examined with instructed movement. Postoperative inspection showed no symptom of inflammation. Conclusions : Local anesthesia with epinephrine, electro-cauterization and transient tourniquet for major hand surgery can save time and obtain wide-awake effect, which would satisfy both doctors and patients.