[Digital necrosis after local anaesthesia with epinephrine]

Abstract

Background: To date, there is a lack of consensus concerning the application of local anaesthetics with epinephrine in fingers, due to the alleged risk of ischaemic complications.

Case description: We present the case of a 70-year old woman, with a medical history of diabetes mellitus and an ischemic cerebral infarct, who underwent operative trigger finger release under local anaesthetics with 1% lidocaine-epinephrine (1:100,000) solution. A few hours later, she developed persisting numbness and ischemic symptoms of the digits. Initial antithrombotic treatment with nadroparin did not resolve the issue, but vasodilatory treatment with nifedipine improved symptoms. Nevertheless, digital necrosis developed in the affected fingers several weeks later. Post-operatively, severe atherosclerosis was diagnosed in the affected hand.

Conclusion: The use of local anaesthesia in conjunction with epinephrine for surgery on digits does offer advantages, but caution is warranted for patients with risk factors predisposing for local circulatory insufficiency. Timely vasodilatory treatment with phentolamine is the preferred option for patients who develop acute ischaemia following local anaesthesia with epinephrine.