Digital gangrene in a patient with primary Raynaud’s phenomenon

Ravindran, Vinod; Rajendran, Suresh

doi:10.4997/jrcpe.2012.106

Cited by 25 publications

(16 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Digital necrosis was described following the localized use of lidocaine/epinephrine in a patient with primary RP . Data concerning sympathomimetic nasal decongestants (pseudoephedrine, phenylephrine) are scarce.…”

Section: Resultsmentioning

confidence: 99%

Drug‐induced Raynaud's phenomenon: beyond β‐adrenoceptor blockers

Khouri

Blaise

Carpentier

et al. 2016

Brit J Clinical Pharma

View full text Add to dashboard Cite

AIMDrug-induced Raynaud's phenomenon (RP) has long been associated with the use of different drugs, including cancer chemotherapy or β-adrenoceptor blockers. However, sources report extremely variable prevalence and the level of evidence for each class is heterogeneous. Moreover, new signals are emerging from case reports and small series. Our objective was therefore to review available evidence about this adverse drug effect and to propose a mechanistic approach of drug-induced RP. METHODSA systematic review of English and French language articles was performed through Medline (1946Medline ( -2015 and Embase (1974Embase ( -2015. Further relevant papers were identified from the reference lists of retrieved articles. RESULTSWe identified 12 classes of drugs responsible for RP, with a variety of underlying mechanisms such as increased sympathetic activation, endothelial dysfunction, neurotoxicity or decreased red blood cell deformability. Cisplatin and bleomycin were associated with the highest risk, followed by β-adrenoceptor blockers. Recent data suggest a possible involvement of tyrosine kinase inhibitors (TKI), through an unknown mechanism. CONCLUSIONDrug-induced RP is a probably underestimated adverse drug event, with limited available evidence regarding its prevalence. Although rare, serious complications like critical digital ischaemia have been reported. When these treatments are started in patients with a history of RP, careful monitoring must be made and, if possible, alternative therapies that do not alter peripheral blood flow should be considered. IntroductionRaynaud's phenomenon (RP) is characterized by transient ischaemia of the extremities in response to environmental stress or emotions [1]. It typically manifests as changes to the fingers, with pallor (vasospasm and decreased blood flow), cyanosis (deoxygenation of the static venous blood) and rubor (reperfusion), often accompanied by pain. RP can be primary (i.e. idiopathic) or secondary to an underlying cause. In both cases, abnormalities of the cutaneous microcirculation are primarily involved in the pathophysiology of RP [2]. The prevalence of RP in the general population varies between 0.5 and 19%, with major geographic variability [3][4][5][6]. While primary RP is the most frequent form (80-90%) [7], RP may also be secondary to various auto-immune diseases (such as systemic sclerosis (SSc), systemic lupus erythematosus, vasculitis, etc.), or other systemic diseases [1]. Several drugs with peripheral vascular effects leading to decreased microvascular perfusion may induce or aggravate RP. Drug-induced RP probably goes unrecognized because of the limited knowledge of this side effect. British Journal of Clinical PharmacologyLiterature reviews and textbooks usually have comprehensively reviewed drugs that have long been known to be responsible for RP [8]. However, new signals are emerging from numerous case reports. Yet, to our knowledge, no systematic review has been performed and little is known about the prevalence and the level of evidence ...

show abstract

Section: Resultsmentioning

confidence: 99%

Drug‐induced Raynaud's phenomenon: beyond β‐adrenoceptor blockers

Khouri

Blaise

Carpentier

et al. 2016

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…29 There have been five cases of digital necrosis with the usage of lignocaine and adrenaline reported between 2012 and 2017. 30 –34 All patients were given adrenaline 1:100,000, except in one case where it was not mentioned. Phentolamine, a potent α-blocker, was given to one patient, which reversed the adrenaline vasoconstrictive effect.…”

Section: Discussionmentioning

confidence: 99%

A randomized controlled trial of trigger finger release under digital anesthesia with (WALANT) and without adrenaline

Rashid

Sapuan

Abdullah

2019

J Orthop Surg (Hong Kong)

View full text Add to dashboard Cite

Background: Trigger finger release utilizing wide-awake local anesthesia no tourniquet (WALANT) usage in extremity surgery is not widely used in our setting due to the possibility of necrosis. Usage of a tourniquet is generally acceptable for providing surgical field hemostasis. We evaluate hemostasis score, surgical field visibility, onset and duration of anesthesia, pain score, and the duration of surgery and potential side effects of WALANT. Methods: Eighty-six patients scheduled for trigger finger release between July 2016 and December 2017 were randomized into a control group (1% lignocaine and 8.4% sodium bicarbonate with arm tourniquet; given 10 min prior to procedure) and an intervention group (1% lignocaine, 1:100,000 of adrenaline and 8.4% sodium bicarbonate; given 30 min prior to procedure), with a total of 4 ml of solution injected around the A1 pulley. The onset of anesthesia and pain score upon injection of the first 1 ml were recorded. After the procedure, the surgeon rated for the hemostasis score (1–10: 1 as no bleeding and 10 being profuse bleeding). Duration of surgery and return of sensation were recorded. Results: Hemostasis score was grouped into visibility score as 1–3: good, 4–6: moderate, and 7–10: poor. The intervention group (with adrenaline) had a 74% of good surgical field visibility compared to 44% from the controlled group (without adrenaline; p < 0.05). Duration of anesthesia was longer in the intervention group (with adrenaline), with a 2.77-h difference. Conclusion: WALANT provides excellent surgical field visibility and is safe and on par with conventional methods but without the usage of a tourniquet and its associated discomfort.

show abstract

“…The literature features four case reports of digital infarction and tissue necrosis associated with the use of local anesthesia with epinephrine in low concentrations. 16 , 17 , 18 , 19 A detailed analysis of these cases indicates that the following factors may be associated with complications: previous diseases, such as Raynaud's phenomenon 16 and atherosclerosis with arterial calcifications, 18 and injection of the anesthetic into the digital sheath. 19 The case reported by Ruiter et al 17 does not allow the conclusion that epinephrine caused tissue necrosis.…”

Section: Discussionmentioning

confidence: 99%

488 hand surgeries with local anesthesia with epinephrine, without a tourniquet, without sedation, and without an anesthesiologist

Sardenberg

Ribak

Colenci

et al. 2018

Revista Brasileira de Ortopedia (English Edition)

View full text Add to dashboard Cite

ObjectivesEvaluate the incidence of digital infarction and tissue necrosis using local anesthesia with 1% lidocaine and 1:100,000 epinephrine in wrist, hand, and fingers surgeries, without a tourniquet, without sedation, and without an anesthesiologist.MethodsPatients with wrist, hand, and fingers disorders prospectively underwent surgery under local anesthesia with 1% lidocaine and 1:100,000 epinephrine. The primary outcomes evaluated were the presence of digital infarction and tissue loss due to necrosis. As secondary outcomes, the need for the use of sedatives, tourniquet, anesthesiologist assistance, or surgery suspension were evaluated.ResultsFifty-three wrists, 307 hands, and 128 fingers were anesthetized with lidocaine and epinephrine without any complications related to epinephrine. There was no patient that presented with any of the primary or secondary outcomes.ConclusionsWrist, hand, and fingers surgeries can be safely performed with local anesthesia with 1% lidocaine and 1:100,000 epinephrine, without sedation, without a tourniquet, and without an anesthesiologist.

show abstract

Digital gangrene in a patient with primary Raynaud’s phenomenon

Cited by 25 publications

References 6 publications

Drug‐induced Raynaud's phenomenon: beyond β‐adrenoceptor blockers

Drug‐induced Raynaud's phenomenon: beyond β‐adrenoceptor blockers

A randomized controlled trial of trigger finger release under digital anesthesia with (WALANT) and without adrenaline

488 hand surgeries with local anesthesia with epinephrine, without a tourniquet, without sedation, and without an anesthesiologist

Contact Info

Product

Resources

About