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KMID : 1143020190240040345
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Archives of Hand and Microsurgery
2019 Volume.24 No. 4 p.345 ~ p.350
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Epinephrine-Induced Digital Vasospasm Reversed by a Phentolamine-Papaverine-Alprostadil Complex: A Case Report
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Koh Sung-Hoon
You Young-Kee
Kim Jin-Soo
Lee Dong-Chul
Roh Si-Young
Lee Kyung-Jin
Hong Min-Ki
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Abstract
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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.
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KEYWORD
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Vasoconstriction, Fingers, Ischemia, Epinephrine, Phentolamine
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