Surgical Procedure re: Lidocaine
As I went about researching how to do digital blocks in preparation for my implantation, I received a lot of conflicting advice about whether lidocaine with epinephrine, as opposed to plain lidocaine, is dangerous in a digital block. I had a couple friends doing their magnet implantations that called it off because someone told them their lido with epi was going to give them gangrene.
I spent some time today and read a few studies that have found that lidocaine with epinephrine is safe to use in digital blocks, and the risk for digital ischemia is not present. I wrote up a more full blog post with sources on my site here, but wanted to also make a post here in the hopes of letting future implanters doing research know that if the only lido they have is lido with epi, they're just fine to do a digital block.
Remember, trust those who know more than you, but trust research as well - part of the hacker ethic is critical evaluation! Don't put blind faith in traditional dogma; always seek the most recent, relevant studies and proof. Trust, but verify.
Tagged:
Comments
I think you need to add this info. The point is vasoconstriction - which in turn keeps the lidocaine in the area and increasing the duration of analgesia. Lid+ Epi can maintain a nerve block for 3 to 4 hours. This is a totally unnecessary duration for the procedure. The only reason to go for epi in this case is perhaps it's all you have.
2nd - tourniquet. If your going to use lido + epi, this changes a number of other factors... particularly it precludes the use of a tourniquet on the digit. The tourniquet and epi both provide hemostasis. Pick one or the other. I would update your blog to mention this.
3rd - dosage. Very important. The meta study for example found 1.7% of those that received Lidocaine with Epi required treatment... generally for cardiac symptoms. It differentiated between "high dose" and "low dose" and states that no one receiving low dose required treatment. However, the way it was described makes absolutely no sense, and for me, discredited the study. It states that the only patients treated for reactions was due to accidental injection of high dose epinephrine 1:1000. 1:1000 is not a dose, but rather a concentration, and it's the appropriate dose for subcutaneous injection. 1:100,000 is used as part of ACLS guidelines to treat AMI, specifically VT or VF.
Take a look at the packaging:
So anyhow, my point is that you should research and provide some dosage information regarding the use of lidocaine with epinephrine. Lidocaine alone doesn't require as close monitoring of dosage. I think you should add maximums etc. for safety if you think epinephrine is a good idea. I personally still don't advise it as I think it adds an unnecessary extra source of complication.
Don't misunderstand me here though. I'm not trying to sound authoritarian or anything. We're both dudes doing research here and I'm not trying to say mine is better. I'm just discussing it.
http://acls-algorithms.com/wp-content/uploads/2011/05/acls-drugs-epi.jpg
Of course, I wouldn't go on a public forum and ask for someone to do something illegal. If I was serious, I would have PM'd you. Just thinking out loud.
Adenosine inhibition - i.e. caffeine sure, sure. Good stuff. So is ephedrine/psuedoephedrine, but there are potential long term cardiac issues. Also each of these stimulants have varying effects on cognition and memory, mix differently with various meds and substances. There's a lot to it. Many many stimulants are either indirectly or even directly affecting acting on the sympathetic nervous system. Epinephrine is the endogenous ligand for this pathway, so it only makes sense that a low dose sampling would be a worth trialing. Now, don't mistake this as being some kind of attempt or interest in getting high or anything. Epinephrine isn't euphoric in the slightest. It's probably nasty like ephedrine; however it's inhalable, insulflatable, and absorbes through mucous membranes etc. It's interesting.