Abstract
Background
The goals of this study were to review the literature regarding the use of local anesthetic with epinephrine and to report an observation of prolonged ischemia and necrosis in postmastectomy skin.
Methods
A PubMed literature review was performed and the patient’s medical record was reviewed.
Results
Prior skin necrosis with epinephrine use in acral areas was often due to physician or manufacturing overdose. Many large studies have confirmed subsequently epinephrine’s safety in acral areas. There are reports of prolonged ischemia in the dermatology literature when used in areas with impaired venous and lymphatic drainage. Our case report suggests that the impaired clearance mechanisms in postmastectomy skin with an underlying implant can lead to ischemia when using local anesthetic with epinephrine.
Conclusions
The addition of epinephrine to local anesthetic increases the duration of analgesia and provides for a relatively bloodless operating field. In the past many surgeons were reluctant to use it because of concerns about arterial vasospasm and tissue necrosis. However, perceptions have recently changed as large reviews have documented its safe use in acral areas. Based on our review of the literature and this case, epinephrine use may not be appropriate in patients with compromised venous and lymphatic drainage.
References
Bunnell S (1956) Surgery of the hand, 3rd edn. JB Lippincott, Philadelphia, p 103
Emsen IM (2006) Catastrophic complication of the circumcision that carried out with local anesthesia contained adrenaline. J Trauma 60:1150–1151
Hinterberger JW, Kintzi HE (1994) Phentolamine reversal of epinephrine-induced digital vasospasm. Arch Fam Med 3:193–195
McCauley WA, Gerace RV, Scilley C (1991) Treatment of accidental digital injection of epinephrine. Ann Emerg Med 20:665–668
Hafner HM, Rocken M, Breuninger H (2005) Epinephrine-supplemented local anesthetics for ear and nose surgery: clinical use without complications in more than 10,000 surgical procedures. J Dtsch Dermatol Ges 3:195–199
Sylaidis P, Logan A (1998) Digital blocks with adrenaline. An old dogma refuted. J Hand Surg Br 23:17–19
Denkler K (2001) A comprehensive review of epinephrine in the finger: to do or not to do. Plast Reconstr Surg 108:114–124
Bellinger CG (1972) Adding a given concentration of epinephrine to a solution by needle drops. Plast Reconstr Surg 50:530–531
Lalonde D, Bell M, Benoit P, Sparkes G, Denkler K, Chang P (2005) A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie project clinical phase. J Hand Surg 30A:1061–1067
Olivencia JA (1996) Ambulatory phlebectomy. A rare complication of local anesthetic: case report and literature review. Dermatol Surg 22:53–55
Olivencia JA (1997) Complications of ambulatory phlebectomy: review of 1000 consecutive cases. Dermatol Surg 23:51–54
Stoebner PE, Téot L, Colonna G, Habib F, Meunier L (2006) Skin necrosis after ambulatory phlebectomy: reconstructive surgery using an artificial dermis. Dermatol Surg 32:972–975
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hartzell, T.L., Sangji, N.F. & Hertl, M.C. Ischemia of Postmastectomy Skin After Infiltration of Local Anesthetic with Epinephrine: A Case Report and Review of the Literature. Aesth Plast Surg 34, 782–784 (2010). https://doi.org/10.1007/s00266-010-9528-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-010-9528-4