Do not use epinephrine in digital blocks

Myth or truth?

B. J. Wilhelmi, S. J. Blackwell, J. H. Miller, J. S. Mancoll, T. Dardano, A. Tran, Linda Phillips

Research output: Contribution to journalArticle

109 Citations (Scopus)

Abstract

The purpose of this study was to examine the role for epinephrine augmentation of digital block anesthesia by safely prolonging its duration of action and providing a temporary hemostatic effect. After obtaining approval from the review board of the authors' institution, 60 digital block procedures were performed in a prospective randomized double-blinded study. The digital blocks were performed using the dorsal approach. All anesthetics were delivered to treat either posttraumatic injuries or elective conditions. Of the 60 digital block procedures, 31 were randomized to lidocaine with epinephrine and 29 to plain lidocaine. Of the procedures performed using lidocaine with epinephrine, one patient required an additional injection versus five of the patients who were given plain lidocaine (ρ = 0.098). The need for control of bleeding required digital tourniquet use in 20 of 29 block procedures with plain lidocaine and in 9 of 31 procedures using lidocaine with epinephrine (ρ < 0.002). Two patients experienced complications after plain lidocaine blocks, while no complications occurred after lidocaine with epinephrine blocks (ρ = 0.23). By prolonging lidocaine's duration of action, epinephrine may prevent the need for an additional injection and prolong post-procedure pain relief. This study demonstrated that the temporary hemostatic effect of epinephrine decreased the need for, and thus the potential risk of, using a digital tourniquet (ρ < 0.002). As the temporary vasoconstrictor effect is reversible, the threat of complication from vasoconstrictor-induced ischemia is theoretical.

Original languageEnglish (US)
Pages (from-to)393-397
Number of pages5
JournalPlastic and Reconstructive Surgery
Volume107
Issue number2
StatePublished - 2001

Fingerprint

Lidocaine
Epinephrine
Tourniquets
Vasoconstrictor Agents
Hemostatics
Injections
Anesthetics
Ischemia
Anesthesia
Hemorrhage
Pain
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery

Cite this

Wilhelmi, B. J., Blackwell, S. J., Miller, J. H., Mancoll, J. S., Dardano, T., Tran, A., & Phillips, L. (2001). Do not use epinephrine in digital blocks: Myth or truth? Plastic and Reconstructive Surgery, 107(2), 393-397.

Do not use epinephrine in digital blocks : Myth or truth? / Wilhelmi, B. J.; Blackwell, S. J.; Miller, J. H.; Mancoll, J. S.; Dardano, T.; Tran, A.; Phillips, Linda.

In: Plastic and Reconstructive Surgery, Vol. 107, No. 2, 2001, p. 393-397.

Research output: Contribution to journalArticle

Wilhelmi, BJ, Blackwell, SJ, Miller, JH, Mancoll, JS, Dardano, T, Tran, A & Phillips, L 2001, 'Do not use epinephrine in digital blocks: Myth or truth?', Plastic and Reconstructive Surgery, vol. 107, no. 2, pp. 393-397.
Wilhelmi BJ, Blackwell SJ, Miller JH, Mancoll JS, Dardano T, Tran A et al. Do not use epinephrine in digital blocks: Myth or truth? Plastic and Reconstructive Surgery. 2001;107(2):393-397.
Wilhelmi, B. J. ; Blackwell, S. J. ; Miller, J. H. ; Mancoll, J. S. ; Dardano, T. ; Tran, A. ; Phillips, Linda. / Do not use epinephrine in digital blocks : Myth or truth?. In: Plastic and Reconstructive Surgery. 2001 ; Vol. 107, No. 2. pp. 393-397.
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