Digital Necrosis After Lidocaine and Epinephrine Injection in the Flexor Tendon Sheath Without Phentolamine Rescue

详细信息    查看全文

• 作者：Jacques X. Zhang ; BSc^&lowast ; ; ^{jacques.zhang@alumni.ubc.ca} ; Jason Gray ; MD^&dagger ; ; Donald H. Lalonde ; MD^&Dagger ; ; Nicholas Carr ; MD^§ ;
• 关键词：Epinephrine ; finger necrosis ; local anesthetic ; phentolamine rescue ; sheath injection
• 刊名：The Journal of Hand Surgery
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：42
• 期：2
• 页码：e119-e123
• 全文大小：2318 K
• 卷排序：42

文摘

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.