To the Editor: Adrenaline is often added to local anaesthetic for injection because the vasoconstrictive effect of the catecholamine counteracts the dilative effect of the local anaesthetic, decreasing systemic absorption and prolonging its action.1 Traditionally, the use of this drug combination has been discouraged in structures supplied by end arteries — most notably the digits, but also the nose, ears and penis — on the basis that it may precipitate irreversible arterial vasospasm, leading to tissue necrosis.
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- 1. Jeng CL, Rosenblatt MA. Overview of peripheral nerve blocks. Waltham, MA: UpToDate, 2011. http://www.uptodate.com/contents/overview-of-peripheral-nerve-blocks (accessed Aug 2012).
- 2. Denkler K. A comprehensive review of epinephrine in the finger: to do or not to do. Plast Reconstr Surg 2001; 108: 114-124.
- 3. Lalonde D, Bell M, Benoit P, et al. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase. J Hand Surg Am 2005; 30: 1061-1067.
- 4. Sönmez A, Yaman M, Ersoy B, Numanodlu A. Digital blocks with and without adrenalin: a randomised-controlled study of capillary blood parameters. J Hand Surg Eur Vol 2008; 33: 515-518.
- 5. Lalonde DH, Lalonde JF. Discussion. Do not use epinephrine in digital blocks: myth or truth? Part II. A retrospective review of 1111 cases. Plast Reconstr Surg 2010; 126: 2035-2036.
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