Epinephrine is Safe in Digital Anesthesia: Debunking the Myth of Finger Necrosis and Correcting Persistent...

The application of epinephrine in digit procedures has historically been a subject of debate in medical education. Trainees are often advised to avoid its use in fingers, toes, and other terminal areas due to concerns about tissue ischemia and necrosis. However, numerous studies demonstrate that, when used at appropriate concentrations, epinephrine can be safely administered in these regions, challenging long standing misconceptions. The belief that epinephrine causes digital necrosis stems from outdated reports from the early to mid-20th century, many of which involved procaine or cocaine-anesthetics with inherent vasoconstrictive properties that may have compounded the effects of epinephrine. Additionally, procaine alone has been shown to impair tissue viability, likely contributing to observed necrosis. Some case reports of digital necrosis did not involve epinephrine at all, suggesting alternative causes. Despite this, cautious use of epinephrine in digital anesthesia has been incorporated into contemporary medical education. Many reputable textbooks, journals, and online learning resources continue to advise caution against the use of epinephrine in digits, even in light of extensive research suggesting otherwise. When used at an appropriate concentration (1:100,000) alongside an appropriate reversal agent such as phentolamine, epinephrine in the digits has been demonstrated to be safe, with very few reports of necrosis. The use of epinephrine in hand procedures aligns with current best practices and should not be viewed as controversial. Bridging the gap between evidence and education is essential for training clinicians who are confident, competent, and guided by up-to-date, evidence-based practices.