Lidocaine with Epinephrine is Safe for Finger Laceration Repair
Lidocaine with epinephrine is safe to use for finger laceration repair and should be considered a first-line anesthetic option for this purpose. 1, 2 Multiple systematic reviews and randomized controlled trials have conclusively demonstrated that the traditional prohibition against using epinephrine in terminal areas like fingers is not supported by current evidence.
Safety Evidence
- The American Academy of Dermatology guidelines explicitly state that adding epinephrine to local anesthesia for digits, hands, and feet is safe 1
- Multiple systematic reviews have found no cases of necrosis when epinephrine was added to local infiltrative anesthesia in digits 1
- The historical concern about digital necrosis was based on case reports from before 1950 that involved procaine or cocaine with epinephrine, not lidocaine with epinephrine 3
Benefits of Using Lidocaine with Epinephrine for Finger Lacerations
- Faster onset and longer duration of anesthesia (approximately 200% longer) 1
- Reduced need for tourniquets 2
- Improved hemostasis during the procedure 2
- Lower peak blood levels of lidocaine, reducing risk of toxicity 2
- Allows for a bloodless field without the need for arm tourniquet 4
Optimal Administration
For best results when using lidocaine with epinephrine for finger laceration repair:
- Use the lowest effective concentration of epinephrine (typically 1:100,000 or 1:200,000) 1
- Buffer the anesthetic with sodium bicarbonate to decrease pain during infiltration 1
- For pediatric patients, consider using topical anesthetic/vasoconstrictor combinations first 1
- Allow 10-20 minutes for onset of action or until wound edges appear blanched 1
Special Considerations
While generally safe, some precautions should be noted:
- Rare cases of epinephrine-induced digital vasospasm can occur, particularly in patients with multiple risk factors for vascular compromise 5
- If digital ischemia occurs, it can be reversed with phentolamine 5
- Use caution in patients with infected fingers or poor circulation 6
- Contraindications include allergy to amide anesthetics and grossly contaminated wounds 1
Pediatric Applications
- For children, LAT gel (lidocaine-adrenaline-tetracaine) has been shown to be safe and effective for finger lacerations 7
- LAT gel is more effective on dorsal finger lacerations (68.6% success) than ventral surface lacerations (37.5% success) 7
- For children >17 kg, use 3 mL; for children <17 kg, use 0.175 mL/kg 1
The traditional teaching that epinephrine should not be used in fingers has been thoroughly debunked by modern evidence. Clinicians should feel confident using lidocaine with epinephrine for finger laceration repair, as it provides superior anesthesia and practical advantages compared to plain lidocaine.