Podcast 549:  Just Use Epineprhine

<p><strong>Contributor: Sam Killian, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Classic dogma teaching that epinephrine should not be used in the fingers, nose, penis, and toes when performing local anesthesia due to concerns for ischemia is wrong</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">This has been well documented in multiple literature reviews</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">A prospective, randomized double-blind study compared lidocaine vs lidocaine with epinephrine for finger injuries and the use of epinephrine was associated with less bleeding and better anesthesia</span></li> </ul> <p><strong><em>Editor’s note: in the lidocaine without epinephrine group, 5 (not 7) needed additional dosing of local anesthesia. The groups were also split 29 for lidocaine alone and 31 for lidocaine with epinephrine but we’re in a pandemic so who is noticing anyways</em></strong></p> <p><strong>References</strong></p> <ol> <li><a href= "https://www.ncbi.nlm.nih.gov/pubmed/11214054"><span style= "font-weight: 400;">1</span></a><span style="font-weight: 400;">. Wilhelmi, B.J., et al. Do not use epinephrine in digital blocks: myth or truth?</span> <em><span style="font-weight: 400;">Plast Reconstr Surg</span></em><span style="font-weight: 400;">. 2001 Feb;107(2):393-7.</span></li> <li><a href= "https://www.ncbi.nlm.nih.gov/pubmed/26254284"><span style= "font-weight: 400;">2</span></a><span style="font-weight: 400;">. Ilicki, J. Safety of Epinephrine in Digital Nerve Blocks: A Literature Review.</span> <em><span style="font-weight: 400;">J Emerg Med</span></em><span style="font-weight: 400;">. 2015 Nov;49(5):799-809. doi: 10.1016/j.jemermed.2015.05.038. Epub 2015 Aug 4.</span></li> <li><a href= "https://www.ncbi.nlm.nih.gov/pubmed/?term=Adrenaline+Auto-injector+injuries+to+digits%3B+a+systematic+review+and+recommendations+for+emergency+management."> <span style="font-weigh