• Epinephrine is a well-known and prevalent adjunct

to local anesthetics for peripheral nerve blockade.

– Induces vasoconstriction of local vasculature.

– Prolongs nerve blockade by reducing systemic

absorption.

– Reduces risk of local anesthetic toxicity (LAST).

– Useful marker of potential intravascular injection.

• Both truncal and chest wall blocks tend to have

higher vascular absorption of local anesthetic +

adjuvants.

• Epinephrine can induce adverse cardiovascular

sequelae when administered intravenously.

– β1 receptor agonism on cardiac myocytes increases

chronotropy, shortens refractory period, facilitating

tachyarrhythmias such as SVT.

• Epinephrine often used to facilitate SVT and VT in

electrophysiology studies.

– Direct adrenergic agonism may also precipitate

uncontrolled hypertension.

• In this case, we present a suspected incident of

epinephrine induced SVT following multiple nerve

blocks utilizing epinephrine as an adjunct.