Arch Hand Microsurg.  2019 Dec;24(4):345-350. 10.12790/ahm.2019.24.4.345.

Epinephrine-Induced Digital Vasospasm Reversed by a Phentolamine-Papaverine-Alprostadil Complex: A Case Report

• Koh SH
• You Y
• Kim JS
• Lee DC
• Roh SY
• Lee KJ
• Hong MK

• KMID: 2464470
• DOI: http://doi.org/10.12790/ahm.2019.24.4.345

Abstract

Epinephrine is widely used to treat severe anaphylaxis. However, the accidental injection of epinephrine into regions containing terminal arteries, such as digits, may cause severe vasospasm, leading to digital ischemia, deepithelialization, wound infection, and potential necrosis. To reverse such epinephrine-induced digital ischemia, phentolamine acts as an antagonist of epinephrine by blocking alpha-receptors. However, since a pure phentolamine drug was not readily available at our hospital, we used Standro (a phentolamine-papaverine-alprostadil complex) as an alternative. Profound ischemia in a patient who accidentally injected epinephrine into her right thumb was promptly reversed after the direct drop of Standro on the puncture site. The wound healed completely after 1 week, without any remarkable sequelae. This case study supports the use of the phentolamine complex for the rapid and safe reversal of epinephrine-induced digital ischemia.

Keyword

Vasoconstriction; Fingers; Ischemia; Epinephrine; Phentolamine

MeSH Terms

Anaphylaxis
Arteries
Epinephrine
Fingers
Humans
Ischemia
Necrosis
Phentolamine
Punctures
Thumb
Vasoconstriction
Wound Infection
Wounds and Injuries
Epinephrine
Phentolamine

Figure

• 

  Fig. 1 Epi-Pen penetrating the thumb on arrival to the emergency room. (A) Penetrated Epi-Pen along with pale thumb. (B) X-ray image on arrival.

• 

  Fig. 2 Image of the thumb after the removal of the frame in the emergency room. (A) Needle remaining in the volar pulp without the restoration of blood flow. (B) X-ray image of the needle possibly penetrating the bone.

• 

  Fig. 3 Image obtained immediately after the removal of the needle. (A) No sign of the restoration of blood flow. (B) Pale and cold thumb compared to the adjacent index finger.

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  Fig. 4 Complete restoration of blood flow 2 hours after Standro administration. (A) Pink coloration similar to the adjacent index finger (arrow shows the affected finger). (B) Pink coloration at the volar surface of the thumb.

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