Based on sound medical research, do the benefits now outweigh the risks of using lidocaine with epinephrine in digital blocks?—JIM FERGUSON, PA-C, Nome, Alaska

As a potent vasoconstrictor, epinephrine can be a useful adjunct to lidocaine in the repair of minor lacerations. It not only allows for easier repair by controlling bleeding but also prolongs the effect of anesthesia by reducing local blood flow. This same property, however, has been feared as a possible cause of gangrene, hence the classic admonition to avoid its use in digital blocks (or in the penis, ear pinna, or tip of the nose). But is this backed by good science? One reviewer, who used it in 23 consecutive digital blocks, concluded it was not (Ann Plast Surg. 1998;41:410-414); a review of the literature since 1948 also failed to turn up any reports of epinephrine-caused gangrene. Old habits die hard, however, and almost all textbooks in current use faithfully repeat the warning. Talk to your local plastic surgeon. Mine agrees that the contraindication is outdated and unproven and says that he uses epinephrine in fingers and toes “all the time.”—Reuben W. Zimmerman, PA-C (145-8)

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