From the Guidelines
Epinephrine (epi) should not be used for a lip laceration repair. The traditional teaching has been to avoid epinephrine in end-arterial areas like the fingers, toes, nose, ears, and lips due to concerns about tissue necrosis from vasoconstriction 1. For lip lacerations, plain lidocaine (1% or 2%) without epinephrine is the preferred anesthetic. Typically, 3-5 mL of plain lidocaine is sufficient for most lip lacerations. The anesthetic should be injected slowly around the wound edges, waiting 5-10 minutes for full effect before beginning repair. While recent research has challenged the absolute contraindication of epinephrine in some distal areas like fingers, the lip remains an area where most clinicians avoid epinephrine due to its rich blood supply and the potential risk of compromising tissue perfusion. Additionally, the cosmetic importance of the lip makes any risk of tissue damage particularly concerning. Adequate hemostasis during lip repairs can usually be achieved through direct pressure rather than relying on epinephrine's vasoconstrictive properties.
Some key points to consider when deciding on the use of epinephrine in lip laceration repairs include:
- The potential risk of tissue necrosis from vasoconstriction, particularly in areas with rich blood supply like the lip 1
- The cosmetic importance of the lip and the potential for tissue damage to have long-term consequences
- The availability of alternative methods for achieving hemostasis, such as direct pressure
- The potential benefits of using epinephrine, such as reduced bleeding and improved visibility, do not outweigh the potential risks in this specific context
It's also worth noting that the use of epinephrine in other areas, such as the digits, hands, and feet, has been shown to be safe and effective in some studies 1. However, the lip remains a unique area where the risks associated with epinephrine use are particularly concerning.
In terms of the evidence, the most recent and highest quality study on this topic is from 2016, which recommends avoiding the use of epinephrine in lip laceration repairs due to the potential risks associated with tissue necrosis and compromised tissue perfusion 1. This recommendation is consistent with the traditional teaching on this topic and is supported by the majority of the available evidence.
From the Research
Epi for Lip Lac
- The use of epinephrine in laceration repair is discussed in several studies 2, 3, 4.
- According to a study published in the American Family Physician, local anesthetic with epinephrine in a concentration of up to 1:100,000 is safe for use on digits, and 1:200,000 is safe for use on the nose and ears 2.
- Another study published in the Academic Emergency Medicine journal found that the use of lidocaine, epinephrine, and tetracaine (LET) solution can provide sufficient anesthesia for laceration repair, and that it can reduce the pain of local anesthetic injection 3.
- However, there is no specific mention of using epi for a lip lac in the provided studies.
- A study published in the European Journal of Emergency Medicine discusses the use of LAT gel (lidocaine, adrenaline, and tetracaine) for laceration repair, but it does not specifically address the use of epi for lip lacs 4.
- Other studies provide general information on laceration repair and management, but do not address the specific question of using epi for a lip lac 5, 6.