Subcutaneous Single Injection Digital Block with Epinephrine

Motoki Sonohata,Kazumasa Maeda,Kenji Tsunoda,Kenji Ogawa,Masaaki Mawatari,Hideki Ishii,Akihiko Asami,Satomi Nagamine

doi:10.1155/2012/487650

Motoki Sonohata, Kazumasa Maeda + Show 6 more

Open Access

https://doi.org/10.1155/2012/487650

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Journal: Anesthesiology research and practice	Publication Date: Jul 12, 2011
Citations: 28	License type: CC BY 3.0

Affiliation: Saga University

Abstract

The aim of this study was to investigate the anesthetic effect and risk of epinephrine for subcutaneous single injection digital block. Either 3.0 mL 1.0% Lidocaine or a 3.0 mL 1.0% Lidocaine with (1 : 100,000) epinephrine was injected into the subcutaneous space at the middle point of the palmar digital crease of the 18 middle fingers of 9 healthy volunteers. The SpO2 of the fingers decreased to a maximum of 97. No subjects showed any symptoms of ischemic injury. The time to anesthesia for the fingers was significantly shorter (P < 0.05), and the duration of anesthesia was significantly longer (P < 0.01) for the fingers in the epinephrine group. In conclusion, a subcutaneous single injection digital blocks with 3.0 mL of 1.0% Lidocaine and (1 : 100,000) epinephrine were safe, reducing the time to the onset of anesthesia, while also markedly prolonging the anesthesia.

Highlights

Many specialists feel that local anesthesia with epinephrine should not be used for a digital block
A careful review of the literature from 1880 to 2000 revealed that there were only 48 case reports of digital gangrene and necrosis following local anesthesia in the digits, and most of those were published before 1950 [2]. Those cases of digital gangrene were associated with procaine and cocaine injection with or without epinephrine
Necrosis has never been reported in patients treated with a commercial lidocaine-epinephrine mixture

Summary

Introduction

Many specialists feel that local anesthesia with epinephrine should not be used for a digital block. A careful review of the literature from 1880 to 2000 revealed that there were only 48 case reports of digital gangrene and necrosis following local anesthesia in the digits, and most of those were published before 1950 [2]. Those cases of digital gangrene were associated with procaine and cocaine injection with or without epinephrine. Three studies reported no complications after performing digital blocks using local anesthetics with epinephrine in 93 and 98 patients, respectively [3, 4]

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