• Jacques X Zhang, Jason Gray, Donald H Lalonde, and Nicholas Carr.
• Faculty of Medicine, University of British Columbia, Vancouver, Canada. Electronic address: jacques.zhang@alumni.ubc.ca.
• J Hand Surg Am. 2017 Feb 1; 42 (2): e119-e123.

AbstractThe literature generally supports the safety of epinephrine injection in the digits, but recent case reports describe ischemic adverse events associated with the use of lidocaine and epinephrine in which phentolamine rescue was not performed. We present a case of finger necrosis and subsequent amputation in a patient after 1% lidocaine with 1:100,000 epinephrine was injected in the fat and flexor sheaths in the palm for a 3-finger trigger release. Phentolamine rescue was not performed. All surgeons who use epinephrine in the finger should be prepared to reverse vasoconstriction with phentolamine rescue if there is persistently inadequate perfusion of the fingertip.Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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