UMEM Educational Pearls

Category: Trauma

Title: Lidocaine with Epinephrine and it use on Fingers and Toes

Keywords: Epinephrine, Lidocaine, Fingers, (PubMed Search)

Posted: 2/7/2009 by Michael Bond, MD (Updated: 5/29/2024)
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Lidocaine with Epinephrine and it use on Fingers and Toes

It has been taught for a long time that Lidocaine with Epinephrine should not be used on fingers, toes, ears and nose [There has to be a kid's song in there somewhere] due to the risk of vasoconstricition/vasospasm and possible digitial infarcation.

The short story is that this practice is not supported by the literature, and there are now numerous publications that have shown that lidocaine with epinephrine is safe for use on the finger tips.  It turns out the the original case reports were submitted with procaine and epinephrine and not lidocaine with epinephrine.  Most of the cases of digital infarction where with straight procaine that is now thought to have been contaiminated or too acidic pH close to 1 when injected.

The effects of epinephrine last approximately 6 hours. This time is well within the accepted limit of ischemia for fingers that has been established in digitial replanation.

So why use Lidocaine with Epinephrine:

  1. Provides a longer period of anesthesia
  2. Decreases bleeding which:
    1. Improves visualization of tendons and underlying structures
    2. Makes repairs easier
    3. Decreases need for a torniquet

 

References

Thomson CJ, Lalonde DH, Denkler KA, Feicht AJ. A critical look at the evidence for and against elective epinephrine use in the finger. Plast Reconstr Surg. Jan 2007;119(1):260-266.