Date of Award

Spring 2022

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Lisa Murphy PA-C

Abstract

Epinephrine is often combined with Lidocaine for local anesthetic use as it improves the duration and quality of Lidocaine and promotes wound hemostasis.1-2 Despite these benefits, epinephrine has been historically contraindicated from being injected into fingers, toes, ears and the nose due to concern over the vasoconstrictive properties of epinephrine leading to ischemia in these end-arteriole areas.3-7 However, there is very little documented evidence of this happening with epinephrine use.5-13 An exhaustive review done by Denkler in 2001 reviewed 21 cases between 1889-2001 that involve epinephrine local injection prior to digit ischemia. However, none of these cases used the current pre-mixed lidocaine and epinephrine concentrations and none showed evidence of epinephrine as the sole cause of ischemia. In fact, during the same time period, Denkler revealed 5 separate studies that involve between 23-200,000 patients per study that all fail to document ischemia secondary to local epinephrine injection.5 A review of the literature since 2001 demonstrates similar results; Numerous studies fail to show ischemia secondary to epinephrine injection.9-13 Furthermore, in rare cases where ischemia did occur, Phentolamine or other vasodilatory agents were readily available and given to reverse the effects of epinephrine, resulting in full resolution of symptoms without permanent damage.13-14 From this evidence, it is concluded that the dogma of tissue ischemia secondary to epinephrine injection should be abandoned as local anesthetic with epinephrine is likely safe to use in areas such as the fingers, toes ears and nose in most patients prior to both laceration repairs and surgeries.

Comments

Link to poster presentation: https://arcadia.zoom.us/rec/share/H5_x_IMnP_Zs8fGS21aorFxS2VInucED3Qr6q6OkGFD-roae0BRVYy_69ld2bWuI._bUWKD6c4Z5SuM6I?startTime=1651195883000

Passcode for link: 09ktRG

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Additional Files

Laura Morrissey Capstone Presentation .mp4 (31333 kB)

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The Dogma of Tissue Ischemia with Local Anesthetic and Epinephrine Use

Epinephrine is often combined with Lidocaine for local anesthetic use as it improves the duration and quality of Lidocaine and promotes wound hemostasis.1-2 Despite these benefits, epinephrine has been historically contraindicated from being injected into fingers, toes, ears and the nose due to concern over the vasoconstrictive properties of epinephrine leading to ischemia in these end-arteriole areas.3-7 However, there is very little documented evidence of this happening with epinephrine use.5-13 An exhaustive review done by Denkler in 2001 reviewed 21 cases between 1889-2001 that involve epinephrine local injection prior to digit ischemia. However, none of these cases used the current pre-mixed lidocaine and epinephrine concentrations and none showed evidence of epinephrine as the sole cause of ischemia. In fact, during the same time period, Denkler revealed 5 separate studies that involve between 23-200,000 patients per study that all fail to document ischemia secondary to local epinephrine injection.5 A review of the literature since 2001 demonstrates similar results; Numerous studies fail to show ischemia secondary to epinephrine injection.9-13 Furthermore, in rare cases where ischemia did occur, Phentolamine or other vasodilatory agents were readily available and given to reverse the effects of epinephrine, resulting in full resolution of symptoms without permanent damage.13-14 From this evidence, it is concluded that the dogma of tissue ischemia secondary to epinephrine injection should be abandoned as local anesthetic with epinephrine is likely safe to use in areas such as the fingers, toes ears and nose in most patients prior to both laceration repairs and surgeries.