Do not use epinephrine in digital blocks: myth or truth?

I "quiz‟ nearly every learner on what type of local they use on fingers. Nearly everybody responds that they never use adrenaline on fingers, toes, penises, ears, and noses. The evidence published since 1963 is pretty clear that it is not harmful to use local with dilute adrenalin on end arteries.

The recent article titled Do not use epinephrine in digital blocks: myth or truth? Part II.

A retrospective review of 1111 cases. This paper reviews the literature (again), and reports his experience of performing digital blocks using 1% lidocaine with adrenalin 1:100,000. He injected an average on 5.7cc into patient‟s fingers without a single complication

Sure, it is only a retrospective review of 1111 cases, but the paper‟s results and conclusions agree the pathophysiology, the animal studies, the other retrospective studies, and the other research since 1963. He sums it up by saying- if the finger was warm before the injection, it remains warm after the injection. 

I‟ll inject 1:100,000 adrenalin nearly anywhere that doesn‟t already have a vascular compromise. It prolongs the duration of anesthesia and keeps a blood-free field. I've chatted with a couple of the local plastic guys and their consultants have mixed views about using 1:100,000 on fingers.

This is food for thought and hopefully will stimulate discussion. Practice as your supervising consultant recommends. 

Plast Reconstr Surg. 2010 Dec;126(6):2031-4.