Subcutaneous Single Injection Digital Block with Epinephrine

Abstract

The aim of this study was to investigate the anesthetic effect and risk of epinephrine for subcutaneous single injection digital block. Either 3.0 mL 1.0% Lidocaine or a 3.0 mL 1.0% Lidocaine with (1 : 100,000) epinephrine was injected into the subcutaneous space at the middle point of the palmar digital crease of the 18 middle fingers of 9 healthy volunteers. The SpO2 of the fingers decreased to a maximum of 97. No subjects showed any symptoms of ischemic injury. The time to anesthesia for the fingers was significantly shorter (P < 0.05), and the duration of anesthesia was significantly longer (P < 0.01) for the fingers in the epinephrine group. In conclusion, a subcutaneous single injection digital blocks with 3.0 mL of 1.0% Lidocaine and (1 : 100,000) epinephrine were safe, reducing the time to the onset of anesthesia, while also markedly prolonging the anesthesia.

Paracentral acute middle maculopathy as a finding in patients with severe vision loss following phacoemulsification cataract surgery

“…However, the literature suggests that a low dose of 1:100 000 used in digital surgery is thought to enhance the effects of local anaesthesia without complication, and suggest that higher doses of adrenaline and larger volumes of anaesthetic used lead to a damaging 'compartment syndrome' necrosis. [13][14][15] The balanced salt solution for infusion during the cataract surgery of these cases had a much lower dose of 1:1 000 000. A dilution error is only possible to 1:500 000 as there is only 1 mL in a standard ampoule of 1:1000 adrenaline.…”

Nekrose i fingre og tær etter lokalbedøvelse med adrenalin – en vandrehistorie?

“…Lokalbedøvelse av fingre kan gjøres som lokal infiltrasjon av det området som skal opereres eller, mer vanlig, som en digital blokade. Primaerhensikten med digital blokade er å bedøve de to volare digitalnervene og også eventuelt de to dorsale digitalnervene direkte (fig 1) (16)(17)(18). Sirkulaer injeksjon av fingeren (ringblokade) er ugunstig fordi det krever et større anestesivolum som teoretisk sett kunne kompromittere sirkulasjonen i fingeren.…”

“…Vellykket fingerblokade med lidokain gir bedøvelse i løpet av 3-4 minutter (17,19). Uten adrenalin varer bedøvelsen i omkring en time (17, 20, 21) og normal sensibilitet er gjenvunnet etter omtrent fem timer (16,22,23).…”

Commentary: How Much Is Too Much? Tourniquets and Digital Ischemia

“…There is ample literature studying tourniquet complications and the effects of tourniquets on ischemia and neuromuscular function, but few focus on the digital tourniquet alone. Furthermore, transferring any ischemia data from upper and lower extremity tourniquet study to the digits must be taken with a grain of salt, because the digits are relatively impervious to ischemic insult . It makes little sense that a well‐accepted practice of 2‐hour tourniquet time for upper extremity surgery results in no finger or toe ischemic complications but that digital tourniquet application for longer than 20 minutes would cause nefarious ischemic sequelae, as the authors suggest.…”

“…Furthermore, transferring any ischemia data from upper and lower extremity tourniquet study to the digits must be taken with a grain of salt, because the digits are relatively impervious to ischemic insult. 4,5,12,19 It makes little sense that a well-accepted practice of 2-hour tourniquet time for upper extremity surgery results in no finger or toe ischemic complications but that digital tourniquet application for longer than 20 minutes would cause nefarious ischemic sequelae, as the authors suggest. Perhaps the true risk in digital surgery stems more from the direct tourniquet pressure and neuromuscular injury.…”