title: Digital Necrosis After Lidocaine and Epinephrine Injection in the Flexor Tendon Sheath Without Phentolamine Rescue.
abstract: The literature generally supports the safety of epinephrine injection in the digits, but recent case reports describe ischemic adverse events associated with the use of lidocaine and epinephrine in which phentolamine rescue was not performed. We present a case of finger necrosis and subsequent amputation in a patient after 1% lidocaine with 1:100,000 epinephrine was injected in the fat and flexor sheaths in the palm for a 3-finger trigger release. Phentolamine rescue was not performed. All surgeons who use epinephrine in the finger should be prepared to reverse vasoconstriction with phentolamine rescue if there is persistently inadequate perfusion of the fingertip.
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, Canada. Electronic address: jacques.zhang@alumni.ubc.ca.
authors.forename: Jacques X
authors.initials: JX
authors.lastname: Zhang
authors.affiliation: Division of Plastic Surgery, Royal Jubilee Hospital, Victoria, British Columbia, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Gray
authors.affiliation: Division of Plastic and Reconstructive Surgery, Dalhousie University, Saint John, New Brunswick, Canada.
authors.forename: Donald H
authors.initials: DH
authors.lastname: Lalonde
authors.affiliation: Division of Plastic Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Carr
mesh_terms: D000671:Amputation, Surgical; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects*; D004837:Epinephrine / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D005383:Finger Injuries / Q000139:chemically induced* / Q000601:surgery*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects*; D008875:Middle Aged; D009336:Necrosis / Q000139:chemically induced / Q000601:surgery; D010646:Phentolamine; D052582:Trigger Finger Disorder / Q000188:drug therapy*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000009:adverse effects*
chemical_list: D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D004837:Epinephrine; D010646:Phentolamine
keywords: Epinephrine; finger necrosis; local anesthetic; phentolamine rescue; sheath injection