Adding epinephrine to local anesthetics is recommended to extend the duration of peripheral nerve blocks. We describe in this article two cases of radial nerve injury possible due to coadministration of epinephrine during brachial plexus block.
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1. Aitkenhead A, Coventry DM. Textboook of Anaesthesia (5th edition), Churchill Livingstone Elsevier, 2007, 315-345.
2. Auroy Y, Benhamou D, Bargues L, et al. Major complication of regional anesthesia in France. Anesthesiology 2002; 97:1274-1280.
3. Sinnott CJ, Cogswell III LP, Johnson A, Strichartz GR. On the mechanism by which epinephrine potentiates lidocaine’s peripheral nerve block. Anesth Analg. 2010;111(3):808-10.
4. Vucković I, Dilberović F, Kulenović A, Divanović KA, Voljevica A, Kapur E. Injection pressure as a marker of intraneural injection in procedures of peripheral nerves blockade. Bosn J Basic Med Sci. 2006;6(4):5-12.
5. Hadzic A, Dilberovic F, Shah S, et al. Combination of intraneural injection and high injection pressure leads to fascicular injury and neurologic deficits in dogs. Reg Anesth Pain Med. 2004;29(5):417-423.
6. Lupu CM, Kiehl TR, Chan VW, El-Beheiry H, Madden M, Brull R. Nerve expansion seen on ultrasound predicts histologic but not functional nerve injury after intraneural injection in pigs. Reg Anesth Pain Med. 2010;35(2):132-139.
7. Yang S, Abrahams MS, Hurn PD, Grafe MR, Kirsch JR. Local anesthetic Schwann cell toxicity is time and concentration dependent. Reg Anesth Pain Med. 2011;36(5):444-451.
8. Benhamou D, Blonski E, Lévy P, Plessis E, Chalhoub V. Ultralong duration of a peripheral nerve block: a possible consequence of intraneural (subepineural) local anaesthetic injection. Ann Fr Anesth Reanim. 2010;29(7-8):589-591.
9. Selander D, Brattsand R, Lundborg G, Nordborg C, Olsson Y. Local anesthetics: importance of mode of application, concentration and adrenaline for the appearance of nerve lesions. An experimental study of axonal degeneration and barrier damage after intrafascicular injection or topical application of bupivacaine (Marcain). Acta Anaesthesiol Scand. 1979;23(2):127-136.