title: Delayed-Onset Digital Ischemia After Local Anesthetic With Epinephrine Injection Requiring Phentolamine Reversal.
abstract: The use of low-dose epinephrine in hand surgery has made it possible to perform a wide range of surgical procedures in the office setting. Low-dose epinephrine use is safe, and its vasoconstrictive effects are reversible with phentolamine. In this report, we present late-onset finger ischemia beginning 3 hours after an ipsilateral carpal tunnel and A1 pulley release of the middle finger anesthetized with local anesthetic and low-dose epinephrine (1:100,000). Finger ischemia lasted 14 hours until rescued with phentolamine injection.
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Andy F
authors.initials: AF
authors.lastname: Zhu
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Brandon R
authors.initials: BR
authors.lastname: Hood
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Morris
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI. Electronic address: kozer@umich.edu.
authors.forename: Kagan
authors.initials: K
authors.lastname: Ozer
mesh_terms: D000368:Aged; D000779:Anesthetics, Local; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002349:Carpal Tunnel Syndrome / Q000601:surgery; D004837:Epinephrine / Q000009:adverse effects*; D005260:Female; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000188:drug therapy / Q000209:etiology*; D010646:Phentolamine / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology; D014662:Vasoconstrictor Agents / Q000009:adverse effects*
chemical_list: D000779:Anesthetics, Local; D000959:Antihypertensive Agents; D014662:Vasoconstrictor Agents; D004837:Epinephrine; D010646:Phentolamine
keywords: Anesthesia; carpal tunnel syndrome; digital ischemia; epinephrine; phentolamine