Hemodynamic and blockade effects of high/low epinephrine doses during axillary brachial plexus blockade with lidocaine 1.5%: A randomized, double-blinded study.
OBJECTIVE
Although epinephrine commonly is added to local anesthetics for regional anesthesia, rarely it may cause undesirable hemodynamic side effects. This study compared the hemodynamic and blockade effects of 25 and 200 microg epinephrine during axillary brachial plexus blockade with lidocaine 1.5%.


METHODS
Sixty American Society of Anesthesiologist classification I or II patients were divided randomly into 3 groups. Patients in group 1 received 5 mL of saline containing 25 microg epinephrine and then 35 mL of 1.5% lidocaine; patients in group 2 received 5 mL of saline alone and then 200 microg of epinephrine mixed with 35 mL of 1.5% lidocaine; patients in group 3 received 5 mL of saline alone and then 35 mL of 1.5% lidocaine. Hemodynamic data were measured for 1 to 10 minutes at 1-minute intervals after axillary injection. The duration time of motor and sensory block was recorded.


RESULTS
Complete anesthesia was achieved in 85% of patients in groups 1 and 3 and 90% in group 2. Motor block duration was significantly longer in group 2 than in groups 1 and 3 (P <.05). There were no significant differences in analgesia between groups 1 and 2. Analgesia duration was significantly longer in groups 1 and 2 than in group 3 (P <.05). Heart rate from the 3rd to 6th minute was higher in group 2 than in groups 1 and 3 (P <.05). Systolic arterial pressure from the 3rd to 5th minute and diastolic arterial pressure from 2nd to 6th minute were higher in group 2 than in groups 1 and 3 (P <.05).


CONCLUSIONS
Low-dose epinephrine offers more stable hemodynamics and similar blockade, and thus may be beneficial for patients undergoing forearm and hand surgery who are at risk for tachycardia and/or hypertension.
Dogru
Kudret
K
Erciyes University Medical Faculty, Kayseri, Turkey. kdogru@erciyes.edu.tr
Duygulu
Fuat
F
Yildiz
Karamehmet
K
Kotanoglu
Mustafa Sirri
MS
Madenoglu
Halit
H
Boyaci
Adem
A
D000293:Adolescent; D000322:Adrenergic Agonists / Q000494:pharmacology; D000328:Adult; D019162:Anesthetics, Combined / Q000494:pharmacology; D000779:Anesthetics, Local / Q000627:therapeutic use; D001365:Axilla; D001917:Brachial Plexus; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004357:Drug Synergism; D004837:Epinephrine / Q000494:pharmacology*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods* / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome
D000322:Adrenergic Agonists; D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D008012:Lidocaine; D004837:Epinephrine