Case reports have warned dentists,1 plastic surgeons,2 otolaryngologists,3 and dermatologists4 of potential malignant hypertension following subcutaneous injections containing epinephrine. Patients taking noncardioselective β-adrenergic blocking agents (β-blockers), such as propranolol hydrochloride, might be especially susceptible since unopposed α-adrenergic vasoconstriction could result.5 We examined the rate of adverse reactions to subcutaneous epinephrine injections in typical dermatology practices.
Records of 2 dermatologists were reviewed for minor surgical procedures that included small amounts of epinephrine in a subcutaneous injection for anesthesia and/or vasoconstriction. One hundred fourteen patients taking β-blockers (mean [±SD] age, 70±11 years; 75 [66%] had a history of hypertension) received 1% or 2% lidocaine hydrochloride with epinephrine (1:100 000; mean [±SD] volume of injection, 2.1±1.5 mL; range of volume, 1-9 mL) (Figure) for 132 procedures. Seventy-four patients (65%) were taking a cardioselective β-blocker and 37 (32%) were taking a nonselective β-blocker (18 were taking propranolol).
Berbaum MW, Bredle DL. Absence of Significant Adverse Effects From Low-Dose Subcutaneous Epinephrine in Dermatologic Procedures. Arch Dermatol. 1997;133(10):1318-1319. doi:10.1001/archderm.1997.03890460144030