Emergency Physicians Monthly - November 16, 2015 - By Salim Rezaie
"If you are like me you have been trained to not use epinephrine in digital nerve blocks. As a matter of fact I was taught NEVER to use epinephrine for regional nerve blocks involving the, “fingers, ears, toes, nose, and hose.” The fear is that the use of epinephrine will cause vasoconstriction and ultimately cause necrosis of tissue distally, due to the lack of collateral blood flow. This belief has been passed down from generation to generation of medical providers and quite honestly been accepted most likely because it makes physiological sense, but needs to be seriously challenged. Using epinephrine in digital nerve blocks may benefit patients by speeding up onset and helping prolong the effect of anesthesia.
What is the Clinical Bottom Line?
- Use of 1:100,000 – 1:200,000 epinephrine in digital nerve blocks is safe in patients who have no evidence of digital vascular disease.
- Use of 1:100,000 – 1:200,000 epinephrine in digital nerve blocks is less well studied and probably safe in patients with poor peripheral circulation, but consider holding the epinephrine in these cases.
- If you need to reverse ischemia after the use of epinephrine start with warm water soaks and/or topical nitroglycerin paste, but if this does not work, consider using 1– 2 mg of Phentolamine at the site of injection."
http://epmonthly.com/article/drop-the-dogma-is-it-time-to-use-epinephrine-for-digital-nerve-blocks/