Treatment of Peripheral Ischemia Secondary to Lidocaine Containing Epinephrine

Aycock, Bobby G.; Hawtof, David B.; Moody, Steven B.

doi:10.1097/00000637-198907000-00005

Cited by 17 publications

(8 citation statements)

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“…59 While one early report described a vasopressor extravasation injury that did not respond to phentolamine administered 48 hours after extravasation, 60 a later animal study demonstrated that early administration of phentolamine was critical to its beneficial effects on vasopressor extravasation injuries. 61 Results of these animal studies are supported by the findings of several case reports, 62,63 and administration of phentolamine no more than 12 hours after extravasation is supported in empirical guidelines for the management of vasopressor extravasation in both children 32,58 and adults. 17…”

Section: Phentolaminementioning

confidence: 54%

Infiltration and Extravasation

Doellman

Hadaway²,

Bowe-Geddes³

et al. 2009

Journal of Infusion Nursing

181

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Infiltration and extravasation are risks of intravenous administration therapy involving unintended leakage of solution into the surrounding tissue. Consequences range from local irritation to amputation. While immediate action using appropriate measures (ie, dilution, extraction, antidotes, and supportive treatments) can decrease the need for surgical intervention, many injuries may be prevented by following established policy and procedures. However, timely surgical intervention, when necessary, can prevent more serious adverse outcomes. Clinicians should be prepared to act promptly when an event occurs. Thorough incident documentation helps determine whether infusion care meets the standard of practice and is a keystone to medicolegal defense.

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Section: Phentolaminementioning

confidence: 54%

Infiltration and Extravasation

Doellman

Hadaway²,

Bowe-Geddes³

et al. 2009

Journal of Infusion Nursing

181

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“…The principal findings of our study are that: (1) the duration of cutaneous anesthesia elicited by tonicaine is longer than that elicited by lidocaine and is further increased by epi; (2) in contrast with lidocaine, tonicaine elicits slower onset of block, which is not significantly affected by the addition of epi; and (3) the addition of epi to the higher concentrations of tonicaine may result in local skin toxicity.…”

Section: Discussionmentioning

confidence: 68%

“…Although the duration of infiltration anesthesia can be increased and the plasma uptake of LAs can be decreased by the addition of vasoconstrictors, such as epinephrine (epi), 1 the fact that epi can induce vasospasm of terminal arteries and result in ischemia of end organs (e.g., hands, feet, earlobes, penis) is a relative contraindication to its use in such areas. 2 Systemic absorption of epi after infiltration with local anesthetics from other sites (where the use of epi is otherwise not contraindicated) gives rise to complications, such as cardiac arrhythmias, cardiac ischemia and/or infarction, hypertension, decreased uterine and renal perfusion, hypokalemia, and subarachnoid hemorrhage. [3][4][5] Thus, the use of epi may be hazardous, especially in cardiac and some obstetric patients.…”

mentioning

confidence: 99%

Use of a charged lidocaine derivative, tonicaine, for prolonged infiltration anesthesia☆

Khan

Gerner²,

Sudoh

et al. 2002

Regional Anesthesia and Pain Medicine

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“…Her pain also persisted with gradual improvement throughout 7 years of follow‐up. Her nerve injury was attributed to ischemia from epinephrine‐induced vasospasm, a known complication of distal nerve blocks 19–22 …”

Section: Discussionmentioning

confidence: 99%

Comparing Partial and Total Tibial‐Nerve Axotomy: Long‐Term Effects on Prevalence and Location of Evoked Pain Behaviors

Ünal-Çevik

Oaklander

2010

Pain Practice

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Monophasic (one-time) nerve injuries heal without clinically significant residua in most cases, but rare individuals are left with neuropathic pain, even after seemingly minor lesions. The effects of lesion size on risk for chronic pain persistence are not well understood, particularly as concerns the complex regional pain syndrome, which is defined in part by pain "disproportionate" to the severity of the causative lesion, and extending outside the autonomous territory of a single nerve. To better clarify the expected prevalence of pain behaviors after nerve injury, we compared the effects in rats of different-sized axotomies on the prevalence and location of evoked pain behaviors. To highlight clinical relevance, we also describe a patient with iatrogenic tibial-nerve injury causing similar chronic neuralgia. Adult male Sprague-Dawley rats were anesthetized and had either 1/3, 2/3 or their entire left tibial nerves tightly ligated at two sites just below the sciatic trifurcation and the interposed nerve was cut. Unoperated rats provided controls. Sensory function in the tibial and sural-innervated territories of both plantar hindpaws was assessed for as long as 6 months postoperatively. Soon after surgery, evoked pain behavior developed in the ipsilesional sural-innervated site in a subset of axotomized rats and recovery was variable. The relationship between lesion size and prevalence and severity of hyperalgesia varied for different pain behaviors, with pinprick hyperalgesia clearly more likely after larger axotomies. In summary, partial tibial-nerve injury in rats models human disease and suggests that expectations of proportionality between lesion size and development of neuropathic pain may need revision.

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Treatment of Peripheral Ischemia Secondary to Lidocaine Containing Epinephrine

Cited by 17 publications

References 0 publications

Infiltration and Extravasation

Infiltration and Extravasation

Use of a charged lidocaine derivative, tonicaine, for prolonged infiltration anesthesia☆

Comparing Partial and Total Tibial‐Nerve Axotomy: Long‐Term Effects on Prevalence and Location of Evoked Pain Behaviors

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