Abstract: Minimize Bleeding With Time Delay Between Epinephrine Injection and Incision (Plastic Surgery 2013)

Saturday, October 12, 2013: 1:25 PM

Daniel E McKee, MD, BSc , Plastic Surgery, McMaster University, Hamilton, ON, Canada

Donald H. Lalonde, MD , Plastic Surgery, Dalhousie University, Saint John, ON, Canada

Achilleas Thoma, MD, MSc , Division of Plastic Surgery; Surgical Outcomes Research Center, McMaster University, Hamilton, ON, Canada

Diana L Glennie, BSc , Department of Medical Physics and Applied Radiation Sciences, McMaster University, Hamilton, ON, Canada

Joseph E Hayward, BSc, PhD , Medical Physics & Applied Radiation Sciences, McMaster University, Hamilton, ON, Canada

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PURPOSE:
The purpose of this study was to see how much time it takes to obtain the lowest cutaneous hemoglobin concentration after lidocaine with epinephrine injection. This will give us a better idea of how long is the ideal waiting time between epinephrine injection and incision in the skin to minimize bleeding.

METHODS:
This was a prospective randomized triple-blinded study (level I evidence) where 12 volunteers were injected simultaneously in each arm with either 1% lidocaine with epinephrine (study group) or 1% lidocaine plain (control group) and the underlying skin and soft tissue’s relative hemoglobin concentration was measured over time using spectroscopy. Tissue reflectance spectroscopy is a validated reproducible technique for measuring total hemoglobin concentrations in soft tissue.

RESULTS:
In the epinephrine group, the mean time where lowest cutaneous hemoglobin was obtained was 25.9 minutes with a 95% confidence interval of 25.9 ± 5.1. This was significantly longer than the historical literature values of 7 to 10 minutes for maximum vasoconstriction after injection. Mean relative hemoglobin index values at every time measurement after 1 minute post injection were significantly different between the lidocaine + epinephrine group and the lidocaine group, using a two-tail paired t-test (p<0.01).

CONCLUSION:
Waiting 25 minutes after injection of local anesthetic with epinephrine before making a skin incision will result in less intraoperative bleeding than waiting only 7-10 minutes. Plastic surgeons already utilizing this concept may inject local anesthetic, leave the injected patient temporarily to perform another task on a different patient, and later return after roughly 25 minutes to begin the procedure on the first patient ¹ ².

21666 Minimize Bleeding With Time Delay Between Epinephrine Injection and Incision