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含肾上腺素的利多卡因及其在指趾麻醉的应用
原作者: Michael Bond,肖锋译 文章来源: 中华急诊医学杂志编辑部 发布日期:2013-03-04

Title: Lidocaine with Epinephrine and it use on Fingers and Toes
题目:含肾上腺素的利多卡因及其在指趾麻醉的应用
Author 作者: Michael Bond
It has been taught for a long time that Lidocaine with Epinephrine should not be used on fingers, toes, ears and nose due to the risk of vasoconstricition/vasospasm and possible digitial infarcation.
长时间以来认为,含有肾上腺素的利多卡因不能用在手指,脚趾,耳朵,和鼻子的麻醉,因为它可产生血管收缩/痉挛,进而导致手指栓塞。
The short story is that this practice is not supported by the literature, and there are now numerous publications that have shown that lidocaine with epinephrine is safe for use on the finger tips. 
这种临床习惯并没有文献支持。相反的,最近有许多文献显示含肾上腺素的利多卡因在手指的麻醉中是安全的。
It turns out the original case reports were submitted with procaine and epinephrine and not lidocaine with epinephrine.  Most of the cases of digital infarction where with straight procaine that is now thought to have been contaiminated or too acidic pH close to 1 when injected.
原来最开始的病例报告都是用的含肾上腺素的普鲁卡因,而不是利多卡因。很多由普鲁卡因造成手指栓塞的病例,现在认为是因为污染或酸性太强,注射后pH接近1。
The effects of epinephrine last approximately 6 hours. This time is well within the accepted limit of ischemia for fingers that has been established in digitial replanation.
肾上腺素的作用大约持续6个小时,这个时间是在已通过手指在移植证实造成手指缺血的可允许范围内。
So why use Lidocaine with Epinephrine:
那么为什么要用含肾上腺素的利多卡因哪:
Provides a longer period of anesthesia
提供能长的麻醉效果
Decreases bleeding which:
减少出血:
Improves visualization of tendons and underlying structures
清楚地看到肌腱和周围结构
Makes repairs easier
容易修复
Decreases need for a tourniquet
减少对止血带的需求
 
References 参考文献
Thomson CJ, Lalonde DH, Denkler KA, Feicht AJ. A critical look at the evidence for and against elective epinephrine use in the finger. Plast Reconstr Surg. Jan 2007;119(1):260-266.

文章来源:中华急诊医学杂志编辑部