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Research ArticleResearch

Evaluation of the safety of epinephrine in digital nerve blockade

Retrospective case series analysis of 1334 toe surgeries

Henry Chapeskie, Alexis Juliao, Sonja Payne and Jennifer Koichopolos
Canadian Family Physician June 2016; 62 (6) e334-e339;
Henry Chapeskie
Medical practitioner at the Thorndale Lions Medical Centre in Thorndale, Ont, and Adjunct Professor in the Department of Family Medicine at Western University in London, Ont.
MD CCFP FCFP
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  • For correspondence: henry.chapeskie@gmail.com
Alexis Juliao
Midwifery student at McMaster University in Hamilton, Ont.
MA
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Sonja Payne
Specialty trainee in anesthetics at the Bristol School of Anaesthesia in the United Kingdom.
MD MSc FRCA
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Jennifer Koichopolos
Medical student at Western University.
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    Figure 1.

    Selection of procedures for inclusion in analysis

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    Table 1.

    Patient and procedural characteristics

    CHARACTERISTICNO DIABETES COMORBIDITY (N = 1289), N (%)DIABETES COMORBIDITY (N = 45), N (%)TOTAL (N = 1334), N (%)
    Age, y
      • ≤ 12101 (7.8)2 (4.4)103 (7.7)
      • 13–18470 (36.5)2 (4.4)472 (35.4)
      • 19–64667 (51.7)30 (66.7)697 (52.2)
      • > 6451 (4.0)11 (24.4)62 (4.6)
    Procedure
      • Nail fold skin excision1172 (90.9)36 (80.0)1208 (90.6)
      • Partial nail avulsion50 (3.9)4 (8.9)54 (4.0)
      • Complete nail avulsion57 (4.4)5 (11.1)62 (4.6)
      • Cautery and curettage10 (0.8)0 (0.0)10 (0.7)
    Vasopressor concentration
      • Epinephrine 1:100 0001127 (87.4)38 (84.4)1165 (87.3)
      • Epinephrine 1:200 000162 (12.6)7 (15.6)169 (12.7)
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    Table 2.

    Postoperative complications

    COMPLICATIONNO DIABETES COMORBIDITY (N = 1289), N (%)DIABETES COMORBIDITY (N = 45), N (%)P VALUE
    Total59 (4.6)2 (4.4).661
    Digital necrosis or ischemia0 (0.0)0 (0.0)NA
    Infection
      • Localized to toe38 (2.9)1 (2.2).618
      • Extension to foot1 (0.1)0 (0.0).966
    Persistent granulation9 (0.7)0 (0.0).734
      Reperfusion injury7 (0.5)0 (0.0).786
      Neuropathy3 (0.2)1 (2.2).128
      Onychomycosis1 (0.1)0 (0.0).966
    • NA—not applicable.

    • View popup
    Table 3.

    Vasoconstrictor concentrations and postoperative complications

    VASOPRESSOR CONCENTRATIONPOSTOPERATIVE COMPLICATIONS,* N (%)TOTAL PROCEDURES
    Epinephrine 1:100 00058 (5.0)1165
    Epinephrine 1:200 0003 (1.8)169
    • ↵* P = .074.

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Canadian Family Physician: 62 (6)
Canadian Family Physician
Vol. 62, Issue 6
1 Jun 2016
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Evaluation of the safety of epinephrine in digital nerve blockade
Henry Chapeskie, Alexis Juliao, Sonja Payne, Jennifer Koichopolos
Canadian Family Physician Jun 2016, 62 (6) e334-e339;

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Canadian Family Physician Jun 2016, 62 (6) e334-e339;
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