PT  - JOURNAL ARTICLE
AU  - Chapeskie, Henry
AU  - Juliao, Alexis
AU  - Payne, Sonja
AU  - Koichopolos, Jennifer
TI  - Evaluation of the safety of epinephrine in digital nerve blockade
DP  - 2016 Jun 01
TA  - Canadian Family Physician
PG  - e334--e339
VI  - 62
IP  - 6
4099  - http://www.cfp.ca/content/62/6/e334.short
4100  - http://www.cfp.ca/content/62/6/e334.full
SO  - Can Fam Physician2016 Jun 01; 62
AB  - Objective To evaluate the safety profile of lidocaine containing 1:200 000 to 1:100 000 epinephrine with concurrent tourniquet use in patients undergoing toe surgery.Design A retrospective case series analysis of toe procedures performed under digital blockade with adjuvant vasopressor from January 25, 2009, to May 31, 2014, was conducted. Exclusion criteria were limited to procedures performed without adjuvant vasopressor use.Setting A single clinic in Ontario.Participants A total of 1334 toe procedures performed in 937 patients.Main outcome measures The primary study outcome was the incidence of postoperative digital necrosis. Secondary outcomes included other postoperative complications including infection, reperfusion injury, persistent granulation, and damage to the nail matrix.Results In total, 1334 toe procedures were included in this study, of which 45 involved patients with a pre-existing diagnosis of diabetes mellitus. The overall incidence of postoperative complications was low (4.6%). No cases of digital ischemia or gangrenous necrosis were observed. Subgroup analysis of patients with and without diabetes showed no statistically significant difference in the rate of complications.Conclusion This study demonstrates the safety of adjuvant vasopressor use in digital nerve blockade of the toes within a large, diverse population. This study adds to a growing base of evidence on the safety of lidocaine with 1:200 000 to 1:100 000 epinephrine for digital anesthesia.