Myth or Modality? Exploring the current perceptions and practices of adrenaline use in musculoskeletal extremities surgery in Pakistan

Objective: To get an overview of current surgical practices for determining the prevalence of myth that Adrenaline containing local anesthetic injections should not be used in acral surgeries because of potential for ischemic necrosis. Methodology: We conducted this descriptive cross-sectional study in Orthopedics and Traumatology Division Lady Reading Hospital MTI Peshawar Pakistan from January 10, 2025 to March 15, 2025. A validated 12 item questionnaire links in google form was sent via email to qualified Orthopedic surgeons who are members of Pakistan Orthopedic Association (POA). The questionnaire assessed the participants current clinical practice regarding frequency and patterns of Adrenaline Containing Local Anesthesia (ACLA) particularly in fingers and toes. Results: We sent 438 emails and received reply from 398(90.86%) participants. Majority (n=318, 79.89%) of the respondents admitted that they use injection Lidocaine (Xylocaine) with Adrenaline containing local anesthesia in their clinical practice. The top three areas for use were surgeries around the wrist (28.30%, n=90), shoulder (23.58%, n=75) and ankle (13.20%, n=42). Most (52.20%, n=166) of our participants still believed in myth and were of the opinion that ACLA should not be used in fingers and toes. Conclusion: The Orthopedic surgeons of Pakistan use injection Lidocaine (Xylocaine) with Adrenaline containing local anesthesia in their clinical practice more frequently in areas other than fingers and toes. Majority of the surgeons still persistently believe in Adrenaline myth and are of the opinion that this should not be used in finger and toe contrary to the reality supported by recent literature that it is completely safe in acral surgeries.