title: Changes in acral blood flux under local application of ropivacaine and lidocaine with and without an adrenaline additive: a double-blind, randomized, placebo-controlled study.
abstract: Vascular effects of local anesthetics are especially important in dermatological surgery. In particular, adequate perfusion must be ensured in order to offset surgical manipulations during surgical interventions at the acra. However, the use of adrenaline additives appears fraught with problems when anesthesia affects the terminal vascular system, particularly during interventions at the fingers, toes, penis, outer ears, and tip of the nose. We studied skin blood flux at the fingerpads via laser Doppler flowmetry over the course of 24 hours in a prospective, double-blind, randomized, placebo-controlled study with 20 vascularly healthy test persons following Oberst's-method anesthetic blocks. In each case, 6 ml ropivacaine (7.5 mg/ml) (A), lidocaine 1% without an additive (B), and lidocaine 1% with an adrenaline additive (1:200,000) (C) was used respectively as a verum. Isotonic saline solution was injected as a placebo (D). Measurements were carried out with the aid of a computer simultaneously at D II and D IV on both hands. Administration of (A) led to increased blood flux (+155.2%); of (B) initially to a decrease of 27%; of (C) to a reduction of 55% which was reversible after 40 minutes and of (D) to no change.(A) resulted in sustained vasodilatation which was still demonstrable after 24 h. (B) had notably less vasodilative effect, although comparison with (D) clearly showed that (B) is indeed vasodilative. (C) resulted in only a passing decrease in perfusion; this was no longer measurable when checked after 6 and 24 h. This transient inadequacy of blood flux also appeared after administration of (D). These tests show that adrenaline additive in local anesthesia does not decrease blood flow more than 55% for a period of 16 min. Following these results an adrenaline additive can be safely used for anesthetic blocks at the acra in healthy persons.
authors.affiliation: Department of Dermatology, University of Tübingen, Germany. hans-martin.haefner@med.uni-tuebingen.de
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Häfner
authors.forename: Ute
authors.initials: U
authors.lastname: Schmid
authors.forename: Matthias
authors.initials: M
authors.lastname: Moehrle
authors.forename: Anke
authors.initials: A
authors.lastname: Strölin
authors.forename: Helmut
authors.initials: H
authors.lastname: Breuninger
mesh_terms: D000328:Adult; D000577:Amides / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D004311:Double-Blind Method; D004338:Drug Combinations; D004837:Epinephrine / Q000494:pharmacology*; D005260:Female; D005385:Fingers / Q000098:blood supply*; D018056:Hemorheology; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D008833:Microcirculation / Q000187:drug effects*; D000077212:Ropivacaine; D014662:Vasoconstrictor Agents / Q000494:pharmacology*
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D004338:Drug Combinations; D014662:Vasoconstrictor Agents; D000077212:Ropivacaine; D008012:Lidocaine; D004837:Epinephrine