As I finished up a long day of finals studying, I thought I’d compile and post some information I’ve learned during my research on digital surgery in preparation for both my own surgery and for general interest.

Digital Blocks

Lidocaine is administered in the form of a digital block for a variety of procedures on the fingers. There are a few types of digital blocks, the most effective seeming to be the transthecal block, which involves an injection of anesthesia into the flexor tendon sheath (this can lead to injection site pain, so appears to be less favorable). Another, slightly easier method is a web block, which injects anesthetic into the web space near the MCP joint – others’ and my method of choice for magnet insertion.

Lido + Epi

Digital block methods have been the subject of some controversy regarding lidocaine with epinephrine. Lidocaine is potentiated by epinephrine, both in terms of effective pain dampening properties and in duration. Unfortunately, epinephrine is a vasoconstrictor, and in the case of the digits of the hand, there is a major concern that the epinephrine can cause constriction to the point of digital ischemia, leading to gangrene issues, necrosis, etc… Not a pretty picture.

However, recent studies have refuted this.

Not So…

This study indicates that while there are cases of digital necrosis in uses of cocaine or procaine, the risks of correctly administered commercial lidocaine with epinephrine are effectively zero. Another meta study (originally retrieved from here, but rehosted for permanence) spells it out especially clearly:

Digital injections of epinephrine were generally safe among all studies reviewed. Only four cases of ischemia were noted, all of which had complete resolution of symptoms. […] The majority of patients did not receive any form of treatment […] digital perfusion persisted in all patients.

Less formal anecdotal responses also exist (here and here), all pointing to the same conclusion: it’s safe.

Despite voluminous proof and research indicating that lido with epi isn’t the one way trip to digital ischemia that traditional biohacking/magplant dogma might suggest, there are still those in the medical community who shy from using L+E, both because of supposed anecdotal evidence and a number of emergency medical training texts: Tintinalli’s most recent Emergency Medicine: a Comprehensive Study Guide states: “Epinephrine should never be used in an end-arterial field, e.g., digits, pinna, nose, penis.”. In a recent chat with an emergency room nurse, I was instructed not to use L+E digitally because “it will stop all blood flow to that area. We use epi in lido almost everywhere else in the body we deaden.”

So What?

For magnet implanters, the main takeaway is that lidocaine with epinephrine is just fine to use for a digital block! While it is best to live by the adage “better safe than sorry,” current wisdom indicates that lidocaine and epinephrine is effective even in web and transthecal blocks, and the risks of digital ischemia are minimal. Biohackers need not worry if the only lido they can find has epinephrine.

Remember, respect those who know more than you, but trust research as well – part of the hacker ethic is critical evaluation! Don’t put blind faith in traditional dogma; always seek the most recent, relevant studies and proof. Trust, but verify.