We tend to practice based on what our attending physicians and residents told us. Some of these lessons we take as gospel and never challenge them. Some you are threatened with death if you even contemplate them! Contrary to the old mantra of “fingers, toes, penis, nose” when it comes to epinephrine, there is actually no literature to support NOT using epinephrine in lacerations of the digits. Sure-if the patient has known severe PAD or Reynaud’s, maybe don’t use it, but otherwise it is fine. Using lido/epi for a digital block is fine-actually helps maintain anesthesia longer. It can also help control bleeding if applied to the wound itself. You aren’t going to have a necrotic finger because of this.
Take a look at this article for more information.
Dr. Patrick O’Malley
The Laceration Course, Course Director