Local anesthetics containing epinephrine should NEVER be used in which of the following areas?

Local anesthetics containing epinephrine are often used to prolong the effects of anesthesia and provide vasoconstriction, which helps minimize bleeding during procedures. However, when applied to certain areas, such as the digits (fingers and toes) and the penis, the risk of ischemia significantly increases. These areas have a relatively poor blood supply compared to larger appendages, and the vasoconstriction caused by epinephrine can lead to tissue necrosis.

The potential for severe complications arises because the blood flow to these regions is already limited, and the addition of vasoconstriction from epinephrine may further impair perfusion. Thus, while epinephrine can be beneficial for controlling bleeding and prolonging anesthesia in other body parts, it should never be used in the digits and penis to avoid the risk of irreversible damage due to insufficient blood supply.