From the FDA Drug Label
CONTRAINDICATIONS Lidocaine HCl is contraindicated in patients with a known history of hypersensitivity to local anesthetics of the amide type. The FDA drug label does not answer the question.
From the Research
Contraindications for Injection of Lidocaine with Epinephrine
The areas where injection of lidocaine with epinephrine is contraindicated include:
- Fingers
- Toes
- Penis
- Outer ear
- Tip of the nose
However, several studies have challenged these contraindications, suggesting that the use of lidocaine with epinephrine in these areas may be safe 1, 2, 3, 4.
Rationale Behind Contraindications
The traditional concern is that epinephrine-induced vasoconstriction may lead to necrosis in areas with end-arteries, such as the fingers, toes, penis, outer ear, and tip of the nose 5.
Reevaluation of Contraindications
Recent studies have found no evidence to support the belief that local anesthesia with epinephrine can cause necrosis in end-arteries 2, 3, 4. In fact, the use of lidocaine with epinephrine in these areas has been shown to be safe and effective, with many clinical and economic advantages 1, 2, 3, 4.