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Epinephrine in digital blocks: refuting dogma.

Peter G Katis¹

¹Emergency Medicine, University Health Network, Toronto, Ontario, Canada.

|May 3, 2007

Summary

Epinephrine is safe to use with lidocaine for digital blocks, contrary to common medical belief. A literature review found no evidence supporting the claim that this combination causes tissue gangrene.

Area of Science:

Medical research
Anesthesiology
Emergency medicine

Background:

A prevalent belief exists in medicine that combining epinephrine with lidocaine for digital blocks causes tissue gangrene.
This notion is perpetuated by major emergency medicine textbooks.
The medical literature lacks robust evidence to support this contraindication.

Purpose of the Study:

To critically evaluate the medical literature regarding the use of epinephrine with lidocaine in digital blocks.
To determine the scientific basis for the contraindication of epinephrine in digital anesthesia.

Main Methods:

Comprehensive review of existing medical literature.
Analysis of studies and case reports concerning digital blocks with epinephrine and lidocaine.

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Assessment of evidence for and against the development of tissue gangrene.

Main Results:

No credible scientific evidence was found to support the claim that epinephrine causes tissue gangrene when used with lidocaine for digital blocks.
Historical or anecdotal reports, rather than empirical data, appear to form the basis of the contraindication.

Conclusions:

The widely held belief that epinephrine should be avoided in digital blocks with lidocaine is not supported by current medical literature.
Clinicians may safely consider using epinephrine with lidocaine for digital anesthesia, pending further evidence.
Re-evaluation of established medical dogma is warranted based on literature review.