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

Affiliations
  • 1Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea. drkim@korea.com

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
Full Text Links
  • AHM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
    DB Error: unknown error