Perceptions and practices of epinephrine use with local anesthetics in end-arterial areas among Jordanian physicians: A cross-sectional survey

Epinephrine is frequently used in combination with local anesthetic agents to enhance their efficacy and duration of action. However, its use in anatomical regions supplied by end arteries remains a topic of controversy. The primary aim of this study was to evaluate physicians' knowledge and practices regarding the use of epinephrine in combination with local anesthetics in end-arterial regions. We also aimed to estimate the prevalence of its use among Jordanian physicians and to examine variations in practice according to physician seniority and medical specialty. A cross-sectional study was conducted using a web-based questionnaire targeting Jordanian physicians. The questionnaire consisted of 3 sections that evaluated participants' demographics, knowledge regarding epinephrine use with local anesthetics in end anatomical arteries, and practices related to general and local anesthesia when performing procedures on these areas. Data were analyzed using Jamovi 2.4.14 software. Of the 336 physicians, 56.5% were males, and 74.4% were aged 35 or younger. General surgery was the most common specialty (61.5%), with 74.7% of participants having <5 years of experience. Residents formed the majority (68.1%), while specialists comprised 31.9%. The overall knowledge about the safety of epinephrine with local anesthesia was low with scores of 3.53 ± 2.20, 2.11 ± 1.95, and 1.57 ± 2.20 for fingers/toes, nose/ears, and penile subgroups, respectively. Our results showed no statistical difference between junior and senior physicians in their choice between general and local anesthesia when operating on the penis (P-values = .564 and .571 for general anesthesia and local anesthesia, respectively). Also, hesitancy in using epinephrine was evident among fingers/toes and penile surgeons, being more obvious in the latter. Despite growing evidence supporting the safety of epinephrine in end-arterial regions, hesitancy remains obvious among Jordanian physicians, particularly in penile surgeries. Limited knowledge and variable practices across specialties highlight the need for targeted education and updated guidelines to fill the gap between evidence-based recommendations and clinical practices.