Smith Isaac L, Siegel Louis J
Touro University California College of Osteopathic Medicine, Vallejo, CA, USA.
St John's Medical Group, Belle Harbor, NY, USA.
J Cutan Aesthet Surg. 2022 Oct-Dec;15(4):418-419. doi: 10.4103/JCAS.JCAS_229_20.
Epinephrine is used in field block anesthesia for cutaneous surgery to enhance the effect of lidocaine and reduce its systemic effects. It has been hypothesized that the use of epinephrine increases the risk for postoperative hemorrhage in cutaneous surgery.
An elderly male was seen in the clinic for excision of a basal cell carcinoma (BCC) in the right upper trapezius area. A field block was performed by injecting lidocaine 1% with epinephrine 1:200,000 (3 mL) circumferentially around the margins of the excision. Adequate hemostasis was achieved during the procedure and the wound was closed without complication. Approximately 45 min post-excision, the patient returned with profuse active bleeding from the wound. The sutures were removed, and an active arterial bleed was identified. The artery was tied off on the lateral side of the wound to achieve hemostasis.
A wearing-off effect of epinephrine may increase the risk for postoperative hemorrhage in cutaneous surgery, wherein an intraoperative arterial nick, masked by localized vasoconstriction, is revealed by a relative postoperative vasodilation. Practitioners should be aware of this potential complication.
肾上腺素用于皮肤外科手术的区域阻滞麻醉，以增强利多卡因的效果并降低其全身效应。据推测，在皮肤外科手术中使用肾上腺素会增加术后出血的风险。
一名老年男性因右上斜方肌区域的基底细胞癌（BCC）切除而就诊于门诊。在切除边缘周围环形注射1%利多卡因加1:200,000肾上腺素（3毫升）进行区域阻滞。手术过程中实现了充分止血，伤口闭合且无并发症。切除后约45分钟，患者因伤口大量活动性出血返回。拆除缝线后，发现一处活动性动脉出血。在伤口外侧结扎动脉以实现止血。
肾上腺素的消退效应可能会增加皮肤外科手术中术后出血的风险，即术中因局部血管收缩而被掩盖的动脉切口，在术后相对血管扩张时显现出来。从业者应意识到这种潜在并发症。
