Using Epinephrine in Digital Blocks: Safety and Recommendations

Evidence Supporting Epinephrine Use in Digital Blocks

Multiple systematic reviews and randomized controlled trials have demonstrated that adding epinephrine to local infiltrative anesthesia is safe for use in digits, hands, and feet, with the American Academy of Dermatology giving an "A" strength recommendation for this practice 1, 2, 3
The use of epinephrine provides several benefits including less need for tourniquets, faster onset, and longer duration of anesthesia, according to the American Academy of Dermatology guidelines 2, 3

The American Academy of Dermatology recommends using concentrations of 1:100,000 and 1:200,000 of epinephrine in dermatologic surgery, as these are the most commonly used and safe concentrations 4
Concentrations of 1:50,000, 1:100,000, and 1:200,000 all show similar effects on vasoconstriction and can prolong anesthetic duration by approximately 200%, as reported by the American Academy of Dermatology 4
The American Academy of Dermatology suggests using the lowest effective concentration of epinephrine to minimize potential side effects such as palpitations and anxiety 4

Patients with stable cardiovascular conditions can safely receive local anesthesia with epinephrine, according to the American Academy of Dermatology 2, 5
Phentolamine should be available as a rescue medication to reverse potential epinephrine-induced vasoconstriction if needed, as recommended by the American Academy of Pediatrics 6