epi finger injection. oops?

14 Aug

commonly taught that Epinephrine should never be injected into a finger,

however the data supporting this is not clear.


Canadian multicenter prospective trial (by plastic surgeons) of 3,110 patients

  • no complications using 1:100,000 epi with digital blocks and preferred this method to tourniquets.
  • reviewed historical account of finger necrosis with epi and found only 21 cases
  • almost all occurred before 1950,
  • were used with Procaine that had no expiration limit at the time, that has been shown to become acidic over a long shelf time (as low as pH of 1).
  • There were a number of cases of necrosis with Procaine with no epi, and necrosis of sites such as the abdominal wall.


Texas Poison control center had 365 cases of accidental epi-pen finger injection

  • none required surgery or amputation,
  • a vasodilator (e.g. nitropaste) was given 23% of the time.


Anecdotally, there is still a sentiment among some that if a finger had necrosis, epi use would not hold up in a malpractice case, despite the data presented in these articles.


Submitted by C. Stokes.


References: Plast. Reconstr Surg 119: 260, 2007. J hand Surg AM, 2005 Sep;30(5):1061-7. Ann Emerg Med. 2010;56:270-274.; picture


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