Treatment of accidental digital injection of epinephrine

A Multicenter Prospective Study of 3,110 Consecutive Cases of Elective Epinephrine Use in the Fingers and Hand: The Dalhousie Project Clinical Phase

“…There are at least 11 reports of phentolamine successfully reversing vasoconstriction in high-dose (1:1,000) accidental epinephrine finger injections. [12][13][14][15][16][17][18][19][20][21][22] Phentolamine rescue was not required in any of the 1,340 finger injections in the patients in this study, nor was phentolamine required in any of the other patients in the combined experience of the 9 authors of over 100 surgeonyears of adrenaline injection without tissue loss before the study. If there had been a significant ischemic event the authors most likely could have rescued the finger with phentolamine.…”

How long does it take phentolamine to reverse adrenaline-induced vasoconstriction in the finger and hand? A prospective, randomized, blinded study: The Dalhousie project experimental phase

“…Surgeons doing elective hand surgery with adrenaline are using low dose (1:100,000) adrenaline. There are many reports of phentolamine successfully reversing accidental high dose (1:1000) adrenaline finger ischemia (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Most important, there is not one documented case of adrenaline-induced finger infarction in which phentolamine was used or considered in the world literature (1).…”

“…Numerous case reports beginning in 1969 document the successful use of phentolamine for the reversal of adrenalinemediated digital ischemia (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). These describe cases of accidental digital injection of high dose (1:1000) adrenaline with autoinjector kits used to reverse insect bite-induced anaphylaxis.…”

Digital Epipen® Injection: A Case of Conservative Management

“…Since the initial reports of accidental epinephrine auto-injector administration into a digit in 1989, local infiltration of phentolamine has been associated with a rapid reversal of digital ischemia within a period of 5 min to a couple of hours without hemodynamic consequences (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). After administration of phentolamine, the digit will appear hyperemic as the effects of the epinephrine are reversed.…”