lidocaine +/- epi

[MD13]

---

Members do not see this ad.

when do you give lido without epi vs with epi?

 

[Smurfette]

Generally speaking, you don't want to use epi on any "appendages" i.e. fingers, ears, nose, toes, penis, etc. due to the more limited blood supply to these areas. The trunk, head, arms and legs are generally fine to use epi on unless there are patient-specific contraindications (i.e. skin flap sites, bad vasculopath, etc.).

 

[tkim]

http://forums.studentdoctor.net/showthread.php?t=762297

 

[username456789]

http://forums.studentdoctor.net/showthread.php?t=762297

Yeah, all the dermatologists I've worked with have had no hesitation whatsoever using epi on noses/finger/penises/etc.

 

[drizzt3117]

Yeah, all the dermatologists I've worked with have had no hesitation whatsoever using epi on noses/finger/penises/etc.

I've seen it used in the bridge of the nose, a lot of attendings don't seem comfortable with it for digital blocks which is unfortunate bc it seems like it'd be most effective in something like a finger in a blender etc.

 

[SLC]

I always understood (perhaps erroneously) that lidocaine with epi was great for any place where you want to limit bleeding. I swear I've seen it used on toes and fingers etc.

 

[Smurfette]

I always understood (perhaps erroneously) that lidocaine with epi was great for any place where you want to limit bleeding. I swear I've seen it used on toes and fingers etc.

You probably have. I've used epi for sites that are classically not supposed to have epi too. IMO, it depends on exactly what you are doing to the patient and how much you are using. But generally speaking, as a student, if someone asks you about using lido + epi, saying "not on appendages" is the safe answer but could be used as a discussion point if you are working with somebody willing to discuss it. Some of my former attendings would freak out if epi was used in certain locations. Let's face it, it takes a long time to get people to change their practice habits and beliefs....the more time you spend in medicine, the more you will see this.

Our ENT guy routinely uses lido+epi on everything, including ears. My partner (gen surg) won't use epi ever.

 

[tkim]

http://uems.buffalo.edu/emergmedvideos/edgrandrounds/orthoMyths/index.html

 

[werd]

yeah it varies by physician where they feel comfortable using the epi. classically it's been discussed that there is some risk on fingers/toes, etc. but it's been shown to be pretty darn safe even on appendages. you run into more problems if you use a large volume of anesthetic and tamponade the blood supply.

you should also avoid significant epi in pregnant patients and pts with pheo or severe peripheral vascular disease.

 

[carrigallen]

When I was a resident, I would always carry a big multidose vial of 2% with Epi in my coat pocket.
Certain hospitals or wards would only stock the regular lidocaine.

 

[medaholic]

Textbook answer: Avoid epi in fingers, tose, nose and hose (penis)
Reality - use it anywhere. Just injected some lidocaine with epi in someone's nose the other day without hesitation. All these places have so much vasculature, it's unlikely to cause ischemia. I think a lot of these "places to avoid" is based on historical anecdotal experiences when they used freezing that had other ingredients in them.