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- Title
Epineph?rine in Digital Nerve Blocks: Medical Mistake or Evidence-Based Practice?
- Authors
Andrews, Joseph A.
- Abstract
Ring blocks are an important component of pain management following digit injury. It has long been believed and taught throughout medical school and post-graduate education that the use of epinephrine must be avoided in digital ring blocks. For most part, this dogma is rooted in historical inaccuracies obtained during the initial development of local anaesthetics in the late 19th and early 20th centuries. Analysis of 50 case reports of digital necrosis after ring blocks reveals confounding factors such as procaine acidity, use of tourniquets, infection, and overuse of anesthesia as likely causes of necrosis. Furthermore, analysis of over 200,000 cases of epinephrine ring blocks failed to identify a single case of digital necrosis. At the physiological level, epinephrine causes vasoconstriction in the digits by binding to adrenergic receptors. However, necrosis does not occur due to the resilience of digits to short-term ischemia. Consequently, use of epinephrine in ring blocks represents best practice because it decreases the time for anesthetic to work, prolongs the anesthetic effect, and produces hemostasis.
- Subjects
ADRENALINE; PAIN management; NERVE block; FINGER injuries; MEDICAL protocols; NECROSIS; EVIDENCE-based medicine; THERAPEUTICS
- Publication
University of Toronto Medical Journal, 2013, Vol 90, Issue 4, p155
- ISSN
0833-2207
- Publication type
Article