In message <[log in to unmask]>, [log in to unmask] writes
>I recently treated an 8 yr. old girl who had inadvertently injected one of
>her fingers with an Epipen. Although the treatment (with phentolamine)
>resulted in symptomatic relief, it caused me to wonder if there was any basis
>to the dogmatic injunction against using vasoconstrictors along with
>anesthetics for digital blocks. I have been unable to turn up any such
>evidence in the literature or on the internet. Does anybody know of any
>instance of the use of a vasoconstrictor with a digital block having actually
>resulted in any harmful long-term sequelae in a human being. I would like to
>use any such information I receive as part of the discussion in a case report
>to be published and would therefore appreciate full details. Thank you.
>A.J. Shankar, MD
>York Hospital
>York, PA
>USA
There are reports of use of axillary block to reduce vasospasm in the
hand after this sort of inadvertent injection.
The problem with the literature on this topic is that it is so enshrined
in medical lore that I doubt that there are any modern papers (I have
never found any). Any that were published are probably very old. They
may well pre-date this fixing of adrenaline content at its present
concentration.
The epipen is a different problem. A higher concentration of adrenaline
and no concomitant vasodilator.
--
Stephen Hughes
|