Letters to the Editor

Myth of Not Using Lidocaine with Epinephrine in the Digits

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Am Fam Physician. 2010 May 15;81(10):1188.

Original Article: Essentials of Skin Laceration Repair

Issue Date: October 15, 2008

Available at: http://www.aafp.org/afp/2008/1015/p945.html

to the editor: Dr. Forsch neatly summarized the essentials of skin laceration repair in this article. However, he continues to promulgate the myth that local anesthetics with epinephrine should not be used in the digits. Historical reviews1 and prospective series in more than 3,000 patients2 have documented that it is safe to use lidocaine (Xylocaine) with epinephrine in the digits. In addition, phentolamine may be injected to reverse digital ischemia hours later, if necessary. Much like naloxone (formerly Narcan) is available to reverse opioid overdoses, phentolamine rescue is always possible; however, I have never needed to use it in my 10-year practice of routinely using lidocaine with epinephrine for finger surgery.3

Physicians treating lacerations in the hand or digits may easily dilute the adrenaline concentration to one half or one fourth by adding plain lidocaine. This practice enables the tissue ischemia to wear off more rapidly and still allows for optimal exposure of the wound. Plain lidocaine, without epinephrine, acts as a vasodilator and increases bleeding.

Author disclosure: Nothing to disclose.


1. Denkler K. A comprehensive review of epinephrine in the finger: to do or not to do. Plast Reconstr Surg. 2001;108(1):114–124.

2. Lalonde D, Bell M, Benoit P, Sparkes G, Denkler K, Chang P. 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 Am. 2005;30(5):1061–1067.

3. Denkler K. Dupuytren's fasciectomies in 60 consecutive digits using lidocaine with epinephrine and no tourniquet. Plast Reconstr Surg. 2005;115(3):802–810.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

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