For decades the commonly held belief that local anaesthesia (LA) with vasoconstrictor can cause necrosis in end-arteries has been sustained by medical teachers, text books and clinical practice. This literature review, identifying 24 articles investigating the use of LA with epinephrine in fingers, toes, noses and ears, including more than 15,000 patients, finds no evidence to support this belief. No case of necrosis has been reported since the introduction of commercial lidocaine with epinephrine in 1948. This review concludes that it is safe to use lidocaine with adrenaline in end-arteries.