Digital block with or without the addition of epinephrine in the anesthetic solution

Almiro dos Reis Júnior; Denise Quinto

doi:10.1016/j.bjane.2013.12.004

Review Article

Digital block with or without the addition of epinephrine in the anesthetic solution

Bloqueios em dedos de mãos com epinefrina incluída ou não nas soluções anestésicas

Almiro dos Reis Júnior; Denise Quinto

http://dx.doi.org/10.1016/j.bjane.2013.12.004 Braz J Anesthesiol, vol.66, n1, p.63-71, 2016

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Abstract

BACKGROUND AND OBJECTIVES: Review of various techniques for digital blocks with local anesthetic, with or without epinephrine. CONTENTS: Description of various procedures and comparison of results reported in the literature, mainly on latency and quality of anesthesia, details on vasoconstrictor effect of epinephrine, intraoperative bleeding, necessity of tourniquet use, duration of anesthesia and postoperative analgesia, blood flow and digital SpO2 behavior, local and systemic complications, and also approaches and drugs to be used in certain situations of ischemia. CONCLUSIONS: The advantages of adding epinephrine to the anesthetic solution are minor when compared to the risks of the procedure, and it seems dangerous to use a vasoconstrictor in the fingers, unless the safety of the technique and the possibility of discarding the tourniquet are definitely proven.

Keywords

Anesthesia, regional, Local anesthetics, cocaine, lidocaine, bupivacaine, ropivacaine, Surgery, fingers, Ischemia, epinephrine

Resumo

JUSTIFICATIVA E OBJETIVOS: Revisão das diversas técnicas para bloqueios em dedos de mãos, com anestésico local associado ou não à epinefrina. CONTEÚDO: São descritos os procedimentos usados e comparados os resultados obtidos na literatura, principalmente em relação a: latência e qualidade da anestesia, detalhes sobre o efeito vasoconstritor da epinefrina, sangramento intraoperatório, necessidade ou não do uso de torniquete, duração da anestesia e da analgesia pós-operatórias, comportamento do fluxo arterial e da SpO2 digitais, complicações locais e sistêmicas e, ainda, condutas e medicamentos a serem usados em determinadas situações de isquemia. CONCLUSÕES: As vantagens da inclusão de epinefrina na solução anestésica são de pouca importância quando comparadas aos riscos do procedimento e parece perigoso usar o vasoconstritor em dedos de mão, a não ser que fiquem definitivamente comprovadas a inocuidade da técnica e a possibilidade do descarte do torniquete.

Palavras-chave

Anestesia, regional, Anestésicos locais, cocaína, lidocaína, bupivacaína, ropivacaína, Cirurgia, dedos de mãos, Isquemia, epinefrina

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Digital block with or without the addition of epinephrine in the anesthetic solution

Bloqueios em dedos de mãos com epinefrina incluída ou não nas soluções anestésicas

Almiro dos Reis Júnior; Denise Quinto

Abstract

Keywords

Resumo

Palavras-chave

References

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