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Necrosis in the toes following local anaesthesia with adrenaline--an urban legend?

Discussion in 'Foot Surgery' started by NewsBot, Dec 16, 2013.

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  1. NewsBot

    NewsBot The Admin that posts the news.

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    Necrosis in fingers and toes following local anaesthesia with adrenaline--an urban legend?
    Finsen V.
    Tidsskr Nor Laegeforen. 2013 Sep 17;133(17):1827-30. doi: 10.4045/tidsskr.13.0373.
     
  2. Paul Bowles

    Paul Bowles Well-Known Member

    If I remember correctly there was an honours research thesis done at UWS bu Naomi Williams (Podiatrist) - I presented the data at the APoDC Podiatry Conference in Tasmania a few years back. From memory (i'd have to dig up the thesis and check) but if I remember correctly the hallux digital perfusion with lignocaine 2% with 1:80,000 never got below 30% of total perfusion at anytime during the procedure. Whats even more interesting is we were measuring capillary bed perfusion sub nail bilaterallly during a PNA procedure and the opposite hallux (control) also recorded a drop in perfusion with no intervention at roughly the same time as the digital injection was issued. Reason? We got puzzled for a bit - but its flight or fight response! Ill have to dig that presentation out but from memory again I think we suggested that with some people the mere thought of having surgery or a needle alone dropped peripheral perfusion significantly.

    Either way it raised a great question. What is the magic number for adequate peripheral perfusion? I am sure we all see limbs with 30% perfusion in PAD patients.......so where is the magic number.
     
  3. Rob Kidd

    Rob Kidd Well-Known Member

    Paul, Ros and her staff at the high risk foot clinic used to undertake nail surgery on patients that were nearly dead with PVD - none dropped off!
     
  4. Paul Bowles

    Paul Bowles Well-Known Member

    Yes I guess that was my point. If we could only ever get a 70% temporary reduction which lasted approximately 30mins what harm could it ever do? Adrenaline and its effect is self limiting largely and you could argue that as a self limiting agent it is safer technically than a tournicot or tourniquet right?

    There will always be exceptions to rules though......

    It was a really well thought out study by Naomi and the questions it raised were fantastic. It was also the study which was responsible for Podiatrists officially having approval by the Board to use adrenaline in NSW at that time....before that time I don't believe any general Podiatrist had ever asked the question!
     
  5. Craig Payne

    Craig Payne Moderator

    Articles:
    8
  6. Paul Bowles

    Paul Bowles Well-Known Member

    Agreed Craig - the Pod Surgeons have been saying the same things for years. I think there is enough evidence for this now to change the dogmatic labeling on the packets from the drug company!
     
  7. Have used lidocaine and 1:80000 adrenaline routinely for most of my local analgesia for 25 years without any problems. For VPs - especially with fractionalisation or Faulkners Needling technique, infiltration with lignocaine special is the local of choice and helps minimise post op haemorrhaging. Most, if not all anaesthetists, will concur fully with this paper.
     
  8. NewsBot

    NewsBot The Admin that posts the news.

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    Can adrenaline safely be used
    in local anaesthesia involving
    distal extremities?
    A systematic review

    Tahsin Stefan Barakat, Mariska de Pagter and Michel ten Have
    Erasmus Journal of Medicine • vol 4 - no 2 - March 2015
     
  9. NewsBot

    NewsBot The Admin that posts the news.

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    1
    Adrenaline with lidocaine for digital nerve blocks.
    Prabhakar H, Rath S, Kalaivani M, Bhanderi N.
    Cochrane Database Syst Rev. 2015 Mar 19
     
  10. NewsBot

    NewsBot The Admin that posts the news.

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  11. NewsBot

    NewsBot The Admin that posts the news.

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    Thermography of the vasodilator effect of local anaesthetics in ingrown toenail surgery
    Ana Belén López Gómez et al
    Source
     
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