Related Experiment Video
Updated: Aug 12, 2026
10:27
An Ultrasonic Tool for Nerve Conduction Block in Diabetic Rat Models
Published on: October 20, 2017
Adrenaline with lidocaine for digital nerve blocks
Hemanshu Prabhakar1, Santosh Rath, Mani Kalaivani
1Department of Neuroanaesthesiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, 110029.
The Cochrane Database of Systematic Reviews
|March 20, 2015
Summary
Limited data suggests adrenaline with lidocaine may prolong anesthesia and reduce bleeding during digital nerve blocks, but more research is needed to confirm safety and efficacy.
Area of Science:
- Anesthesiology
- Surgical Innovation
- Evidence-Based Medicine
Background:
- Digital nerve blocks are common in outpatient surgery.
- Adrenaline (epinephrine) with lidocaine may improve anesthesia duration and surgical hemostasis.
- Concerns exist regarding adrenaline's use in end-artery sites like digits.
Purpose of the Study:
- To evaluate the safety and efficacy of combining adrenaline with lidocaine for digital nerve blocks in fingers and toes.
- To assess outcomes including anesthesia duration, adverse events, and bleeding reduction.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) comparing adrenaline-lidocaine to plain lidocaine.
- Searched multiple databases (CENTRAL, MEDLINE, EMBASE) and clinical trial registries.
- Included four RCTs with 167 participants; risk of bias was high.
Main Results:
- Low-quality evidence suggests adrenaline with lidocaine may prolong anesthesia by approximately 3.2 hours.
- Adrenaline-lidocaine significantly reduced bleeding during surgery (Risk Ratio 0.35).
- No trials reported on adverse events like ischemia or cost-effectiveness.
Conclusions:
- Insufficient evidence to recommend or avoid adrenaline in digital nerve blocks.
- Adrenaline may offer benefits in anesthesia duration and bleeding control, but evidence quality is low.
- Further large-scale RCTs are needed to assess adverse events, cost, and postoperative pain relief.
Related Concept Videos
01:19Depolarizing Blockers: Pharmocokinetics
Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
01:23Local Anesthetics: Common Agents and Their Applications
Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...
01:30Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia
Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...
01:11Local Anesthetics: Clinical Application as Spinal Anesthesia
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
01:29Local Anesthetics: Clinical Application as Epidural Anesthesia
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
01:16Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...