Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Digital anesthesia with epinephrine

Discussion in 'Foot Surgery' started by admin, Nov 3, 2004.

Tags:
  1. admin

    admin Administrator Staff Member


    Members do not see these Ads. Sign Up.
    From latest Journal of the American Academy of Dermatology:
    Digital anesthesia with epinephrine: An old myth revisited

    Abstract


    Comments?
     
    Last edited: Nov 3, 2004
  2. davidh

    davidh Podiatry Arena Veteran

    When I was young and foolish (as opposed to being old and foolish :eek: ) I once did a digital block on my index finger using, if I remember rightly, a 2% solution of lignocaine with epinephrine. I remember the injection being painful, but the finger is still attached, good as new :) .
    Regards,
    David
     
  3. bob

    bob Active Member

    Good Morning,
    See also -
    Radovic P, Smith RG, Shumway D. J Am Podiatr Med Assoc. 2003 Mar-Apr;93(2):157-60

    Anesthetics containing epinephrine have long been thought unsuitable for use in the foot and, particularly, the digits. However, research suggests that epinephrine use is beneficial in the appropriately selected patient. These benefits include a decreased local anesthetic plasma concentration; an increased duration of anesthesia, with a decreased need for additional narcotic use after surgery; decreased development of hemorrhage and postoperative hematoma, without occlusion of vessels; and a lack of complications (in millions of patients reported on in the literature). A retrospective review of more than 150 patients receiving local anesthetics containing epinephrine revealed no complications in the foot and ankle.
     
  4. Robert D. Phillips DPM

    Robert D. Phillips DPM Welcome New Poster

    25 years later

    I have been using epinephrine in digital blocks judiciously for the last 25 years. I think you'll read the PDR to say that epinephrine is to be used cautiously in the digits. A review of JAPMA will find an article by Don Green many years ago showing the bloodflow into the digit after using epinephrine, which would demonstrate very nicely that it is no more dangerous for digital necrosis than puttint a thigh tourniquet on for 1.5-2 hours.

    Every year I have to retrain residents that with a little bit of common sense, epinephrine can be safely used in many if not most patients. I would not use it on someone who already has dependent rubor and no pulses nor on someone who has vasospastic disease.

    Best wishes.
     
  5. summer

    summer Active Member

    Epinephrine

    I don't think medical-legally if there was a problem you would have a good defense. Since the PDR states judicious use only, I think the lawyers with their twisted wording would find some way to convolute the truth. As for me, even though I know it is safe if administered correctly, I'll stick with the torniquet.
     
  6. André Azevedo

    André Azevedo Welcome New Poster

    For me if the pacient have no historie of vascular disease why not the use of epinephrine? However, in Portugal and Spain podiatrists are not recomended to use it. We normaly use the torniquet. By the way i´m for Portugal.
     
  7. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
  8. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Anaesthetic digital block with epinephrine vs. tourniquet in ingrown toenail surgery: a clinical trial on efficacy.
    C?rdoba-Fern?ndez A, Rodr?guez-Delgado FJ.
    J Eur Acad Dermatol Venereol. 2015 May;29(5):985-90
     
  9. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Evaluation of the safety of epinephrine in digital nerve blockade
    Retrospective case series analysis of 1334 toe surgeries

    Henry Chapeskie et al
    Canadian Family Physician June 2016 vol. 62 no. 6 e334-e339
     
  10. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Is Epinephrine Safe for Infant Digit Excision? A Retrospective Review of 402 Polydactyly Excisions in Patients Younger than 6 Months.
    Mantilla-Rivas E, Tan P, Zajac J, Tilt A, Rogers GF, Oh AK.
    Plast Reconstr Surg. 2019 Jul;144(1):149-154
     
  11. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The Dogma of Tissue Ischemia with Local Anesthetic and Epinephrine Use
    Laura Morrissey
    Source
     
Loading...

Share This Page