Anesthetic agents with epinephrine should NOT be used in:a. The fingertip
A commonly held axiom is that epinephrine is unacceptable to be used in the hand. Several recent large series have dispelled this myth. Epinephrine should not be used in the fingertip and not in concentrations higher than 1:100,000 (ie, what is present in commercially available local anesthetic with epinephrine). Beyond that, its use is acceptable and may be useful in an emergency room (ER) where tourniquet control may not be available. Also, because most ER procedures are done under pure local anesthesia, many patients will not tolerate the discomfort of the tourniquet beyond 30 minutes. Epinephrine will provide hemostasis and also prolong the effect of the local anesthetic.