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Reevaluating the epinephrine myth: A comprehensive review.
Sreeganesh Krishnaprabhu1, Joe M Das2
1Department of Orthopedic Surgery, Fatima Hospital, Kochi, Kerala, India.
Indian Journal of Pharmacology
|July 30, 2024
Summary
Local anesthesia with epinephrine is generally safe for acral areas, despite past concerns. A review found few necrosis cases, highlighting the need for careful patient selection and adherence to guidelines.
Area of Science:
- Anesthesiology
- Plastic Surgery
- Dermatology
Background:
- Historically, epinephrine in local anesthesia was contraindicated in acral regions due to necrosis risk.
- Recent studies since 2001 challenge this contraindication, suggesting safety and efficacy.
Purpose of the Study:
- To review and analyze reported cases of acral necrosis after local anesthesia with epinephrine since 2001.
- To assess the current understanding of risks and benefits associated with epinephrine use in acral local anesthesia.
Main Methods:
- Systematic literature search on PubMed and Google Scholar.
- Inclusion of articles reporting acral necrosis following local anesthesia with epinephrine.
Main Results:
- Eight publications identified 13 cases of ischemic events in acral areas.
- Cases included finger (5), scrotal (2), and eyelid (6) necrosis after lignocaine with epinephrine.
- Most affected patients were female undergoing surgical reconstruction.
Conclusions:
- Epinephrine in local anesthesia offers benefits and is generally safe for acral areas.
- Necrosis risk, though low, persists, especially in patients with vascular compromise.
- Proper patient selection, adherence to guidelines, and phentolamine as a rescue agent can mitigate risks.
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