Effect of local epinephrine on cutaneous bloodflow in the human neck.
The effectiveness of local anesthetics is improved by the addition of a vasoconstrictor which increases duration of action and decreases both systemic toxic reactions and local bleeding. Epinephrine, the standard drug for vasoconstriction, has some limitations due to potential dose-related cardiac and local toxic effects. The authors examined the minimal effective epinephrine concentration required for maximal cutaneous vasoconstriction in the human subject so as to limit potential dose-related side effects. In a randomized, double-blinded prospective study, 23 patients undergoing head and neck surgical procedures under general anesthesia were enrolled to quantify the effect of subdermal infiltration of 1% lidocaine with epinephrine at varying concentrations on local cutaneous bloodflow utilizing laser Doppler flowmetry. A comparison of the onset of vasoconstriction and magnitude of diminished bloodflow was made for several commonly used concentrations of epinephrine, with 1% lidocaine and normal saline serving as controls. There were no significant differences (P > .05) between epinephrine concentrations of 1:400,000, 1:200,000, 1:100,000, and 1:50,000 when examining onset and magnitude of vasoconstriction.
Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center, Oakland, Calif, USA.
T P
TP
O'Malley
G N
GN
Postma
M
M
Holtel
D A
DA
Girod
D000768:Anesthesia, General; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000494:pharmacology; D004311:Double-Blind Method; D004837:Epinephrine / Q000494:pharmacology*; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008012:Lidocaine / Q000494:pharmacology; D009333:Neck / Q000098:blood supply; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000187:drug effects; D012867:Skin / Q000098:blood supply*; D013566:Sympathomimetics / Q000494:pharmacology*; D014661:Vasoconstriction / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000494:pharmacology*; D014664:Vasodilation / Q000187:drug effects
D000779:Anesthetics, Local; D013566:Sympathomimetics; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D004837:Epinephrine