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Do Not Use Epinephrine in Digital Blocks: Myth or Truth? Part II. A Retrospective Review of 1111 Cases

Chowdhry, Saeed M.D.; Seidenstricker, Lynn M.D.; Cooney, Damon S. M.D.; Hazani, Ron M.D.; Wilhelmi, Bradon J. M.D.

Plastic and Reconstructive Surgery: December 2010 - Volume 126 - Issue 6 - p 2031-2034
doi: 10.1097/PRS.0b013e3181f44486
Hand/Peripheral Nerve: Original Articles

Background: Epinephrine in digital blocks has been condemned by traditional medical theory. The authors provide a retrospective review of 1111 cases involving digital block anesthesia with epinephrine in conjunction with an extensive literature review.

Methods: The authors conducted a retrospective review of 1111 cases involving digital and hand surgery. Observations were made concerning the location of and indication for surgery, age, sex, type of block used, type and dose of anesthetic, use of epinephrine and concentration, use of a tourniquet, follow-up, and complications. Dorsal and transthecal techniques were used exclusively. Patients with vascular compromise did not receive epinephrine and were excluded from the study.

Results: One thousand one hundred eleven cases were reviewed, distributed among 692 male patients and 419 female patients. Sites of surgery ranged throughout the hand and all fingers for a variety of indications. Five hundred patients received injections of 1% plain lidocaine with a dosage range of 2 to 10 cc and an average of 5.7 cc. Six hundred eleven patients received injections of 1% lidocaine with epinephrine (1:100,000) in a dose range of 0.5 to 10 cc and an average dose of 4.33 cc. Nine hundred eighty-six patients (88.75 percent) followed up in the clinic. No patients suffered from digital gangrene in the epinephrine group.

Conclusions: After reviewing 1111 cases, there were no complications associated with the use of epinephrine in digital blocks. The authors suggest that correct application of epinephrine in digital blocks is appropriate, and defend its use.

Louisville, Ky.; Chicago and Springfield, Ill.; Knoxville, Tenn.; and Pittsburgh, Pa.

From the University of Louisville; Mt. Sinai Medical Center; College of Medicine, University of Tennessee; Southern Illinois University; and the University of Pittsburgh.

Received for publication February 22, 2010; accepted June 14, 2010.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Saeed Chowdhry, M.D.; Mt. Sinai Medical Center; 777 North Michigan Avenue, Unit 2503; Chicago, Ill. 60611;

©2010American Society of Plastic Surgeons