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Phentolamine was more effective when injected into the AAI puncture site (mean resolution time 17 min) in comparison to injection as a digital block (74 min). CONCLUSION Phentolamine is the most effective method of reversing symptoms and treating ischaemic digits when compared to alternative therapies. Symptoms resolved much quicker when phentolamine was infiltrated into the site of injury compared to being infiltrated as a digital block. We propose a treatment algorithm for management of these injuries. Hand surgeons should be aware o