Attempts to Prolong and Intensify Spinal Anesthesia by the Addition Op Ephedrine, Neosynephrin or Epinephrine to a Pontocaine—glucose Solution

Sergent, Warren F.; Dripps, Robert D.

doi:10.1097/00000542-194905000-00002

Cited by 13 publications

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“…The vasoconstrictive properties of ephedrine also seem rather mild, because studies performed approximately 50 yr ago showed controversial results of ephedrine in prolonging spinal anesthesia when added to LAs, 6,7,17,18 such as pontocaine. This relatively high dosage of ephedrine necessary to block the nerve caused us to consider that the nerve blockade might be due, at least in part, to acute ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…6,7,9,18,25,26 However, subtle neurologic deficits may not have been reported. In rat pilot studies, we found that clinical neurotoxicity (as measured by neurobehavioral endpoints) begins at approximately 10% (n ϭ 4, data not shown).…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] It is currently approved by the U.S. Food and Drug Administration for the treatment of nasal congestion, asthma, and hypotension arising from spinal blockade. 6,7 However, and to our surprise, we found that ephedrine was used as a sole LA agent more than half a century ago. 4,5 These adrenergic properties prompted us to reexamine ephedrine as a potential adjuvant for clinical and investigational local anesthetics (LAs).…”

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confidence: 86%

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Ephedrine Blocks Rat Sciatic Nerve In Vivo and Sodium Channels In Vitro

Hung

Kau

Zizza³

et al. 2005

Anesthesiology

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Background:The sympathomimetic drug ephedrine has been used intrathecally as the sole local anesthetic for labor and delivery. Because ephedrine may be a useful adjuvant to local anesthetics, the authors investigated the local anesthetic properties of ephedrine in a rat sciatic nerve block model and the underlying mechanism in cultured cells stably expressing Na ؉ channels.Methods: After approval of the animal protocol, the sciatic nerves of anesthetized rats were exposed by lateral incision of the thighs, 0.2 ml ephedrine at 0.25, 1, 2.5, or 5% and/or bupivacaine at 0.125% was injected, and the wound was closed. Motor and sensory/nociceptive functions were evaluated by the force achieved by pushing against a balance and the reaction to pinch, respectively. The whole cell configuration of the patch clamp technique was used to record Na ؉ currents from human embryonal kidney cells stably transfected with Na v 1.4 channels.Results: The nociception blockade was significantly longer than the motor blockade at test doses of 2.5 and 5% of ephedrine, or when 1% ephedrine was combined with 0.125% bupivacaine (analysis of variance with repeated measures, P < 0.001, n ‫؍‬ 8/group). In vitro, the 50% inhibitory concentrations of ephedrine at ؊150 and ؊60 mV were 1,043 ؎ 70 and 473 ؎ 13 M, respectively. High-frequency stimulation revealed a usedependent block of 18%, similar to most local anesthetics.Conclusions: Because ephedrine's properties are at least partly due to Na ؉ channel blockade, detailed histopathologic investigations are justified to determine the potential of ephedrine as an adjuvant to clinically used local anesthetics.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 86%

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Ephedrine Blocks Rat Sciatic Nerve In Vivo and Sodium Channels In Vitro

Hung

Kau

Zizza³

et al. 2005

Anesthesiology

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“…The addition of vasoconstrictors to local anesthetic mixtures used in spinal anesthesia results in prolongation of the motor and sensory block ( 1,2). This is thought to be due to vasoconstriction of the vessels of the spinal cord and its surrounding structures, delaying vascular absorption of the drug and increasing the exposure of the nervous tissue to the anesthetic agent (3,4). Intravenous and intrathecal vasoconstrictors alone have been reported to produce neurologic deficits related to catecholamine-induced vasospasm in the spinal cord (5,6 ) .…”

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confidence: 99%

Spinal Cord and Cerebral Blood Flow Responses to Subarachnoid Injection of Local Anesthetics with and without Epinephrine

Porter

Albin

Watson

et al. 1985

Acta Anaesthesiol Scand

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Subarachnoid anesthesia with lidocaine, mepivacaine, or tetracaine with and without added epinephrine (1:100 000) produced no demonstrable changes in average cerebral (CBF) or segmental spinal cord blood flow (SCBF) in 38 cats anesthetized with pentobarbital. Blood flow was measured by the injection of radioactive microspheres. Seven groups of cats received either lidocaine 15 mg, lidocaine 15 mg with epinephrine, mepivacaine 10 mg, mepivacaine 10 mg with epinephrine, tetracaine 5 mg, tetracaine 5 mg with epinephrine, or saline with epinephrine 1:100 000. Mean arterial pressure (MAP) decreased significantly (P less than 0.05) in Groups I-VI. Added epinephrine had no effect on the decrease in MAP. Amplitude of the somatosensory cortical evoked response decreased significantly in Groups I-VI, but did not change from control in Group VII. No significant change in CBF or SCBF was demonstrated in any group at any time. Plasma lidocaine and mepivacaine levels were significantly less at 5 min after subarachnoid injection in the groups receiving epinephrine compared to those not receiving epinephrine (P less than 0.05). The data appear to support the hypothesis of a vasoconstrictive reduction in systemic absorption of intrathecal local anesthetics, but suggest that significant segmental spinal cord ischemia does not occur. Maintenance of total flow in the face of a decrease in MAP suggests that autoregulation in brain and spinal cord may be maintained. Changes in regional SCBF or CBF may have been present but were not examined in this study. Further studies of brain and spinal cord blood flow dynamics, regional flow changes, and regulation of flow after intrathecal agents are necessary.

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Spinal (subarachnoid) block. A review of 11,574 cases

Moore¹

1966

JAMA: The Journal of the American Medical Association

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Attempts to Prolong and Intensify Spinal Anesthesia by the Addition Op Ephedrine, Neosynephrin or Epinephrine to a Pontocaine—glucose Solution

Cited by 13 publications

References 0 publications

Ephedrine Blocks Rat Sciatic Nerve In Vivo and Sodium Channels In Vitro

Ephedrine Blocks Rat Sciatic Nerve In Vivo and Sodium Channels In Vitro

Spinal Cord and Cerebral Blood Flow Responses to Subarachnoid Injection of Local Anesthetics with and without Epinephrine

Spinal (subarachnoid) block. A review of 11,574 cases

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