Epinephrine Administered With Lidocaine Solution Does Not Worsen Intrathecal Lidocaine Neurotoxicity in Rats

Komatsu, Toshiaki; Takenami, Tamie; Nara, Yoshihiro; Yagishita, Saburo; Kurashige, Chie; Okamoto, Hirotsugu; Yago, Kazuo

doi:10.1097/aap.0b013e318279499d

Cited by 7 publications

(3 citation statements)

References 22 publications

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“…[21,24,25] In peripheral nerve blocks, epinephrine shows some analgesic effects in combination with short-acting and intermediate-acting local anesthetics such as lidocaine, but similar effects have not been observed in combination with long-acting local anesthetics such as bupivacaine and ropivacaine. [22,23] An epinephrine solution of 25 µg/ml may be an effective marker for intravascular injection of a local anesthetic. It has been suggested that this dose may also transiently increase blood flow to the peripheral nerve itself, probably due to its β-adrenergic effects.…”

Section: Discussionmentioning

confidence: 99%

Epinephrine and Dexamethasone as Adjuvants in Upper Extremity Peripheral Nerve Blocks in Pediatric Patients

Mikjunovikj-Derebanova

Карталов

Кузмановска

et al. 2021

Prilozi

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Introduction: Regional anesthesia in children in recent years has been accepted worldwide. The increased interest in it is partly due to the use of ultrasonography which provides confidence and accuracy to the anesthesiologic team. Adjuvants are used to extend the duration of the sensory and motor blocking, limiting the cumulative dose of local anesthetics. The use of adjuvants in peripheral nerve blocks in the pediatric population is still under research. Aim: To observe the effect of epinephrine and dexamethasone as adjuvants to local anesthetics in peripheral upper extremity nerve blocks in pediatric patients. Materials and methods: The study included 63 patients, aged group 4-14 years, admitted to the University Clinic of Pediatric Surgery for surgical treatment of upper limb fractures in the period of January 2020 until March 2021. Patients were randomized into three groups, and all patients in the groups received analgo-sedation prior to peripheral nerve block. Patients in group 1 (21 patients) received supraclavicular, or interscalene block with 2 ml lidocaine 2% and bupivacaine 0.25% (max 2mg/kg) with a total volume of 0.5ml/kg. In group 2, the patients (21) received 25 μg of epinephrine in 2 ml of 2% solution of lidocaine and 0.25% bupivacaine (max 2 mg/kg) with a total volume of 0.5 ml/kg, and in group 3, the patients (21) received 2% lidocaine 2ml and 0.25% bupivacaine (max 2mg/kg) in combination with 2mg dexamethasone with a total volume of 0.5ml/kg. Results: Results showed that in patients in group 1, the average duration of the sensory block was 7 hours, while the duration of the motor block was 5 hours and 30 minutes. In group 2 (epinephrine), the durations of both sensory and motor block were prolonged for about 30 minutes on average compared to the first group. In group 3 (dexamethasone) the duration of the sensory and motor block was significantly longer compared with the first two groups (p<0.0001). Conclusion: Epinephrine and dexamethasone prolong the duration of action of local anesthetics in peripheral nerve blocks of the upper extremity in pediatric patients and thus reduce the need for analgesics in the postoperative period.

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Section: Discussionmentioning

confidence: 99%

Epinephrine and Dexamethasone as Adjuvants in Upper Extremity Peripheral Nerve Blocks in Pediatric Patients

Mikjunovikj-Derebanova

Карталов

Кузмановска

et al. 2021

Prilozi

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“…Applied as an adjuvant, adrenaline is a relatively safe drug. Studies in rats have not showed an increase in the percentage of either histological or functional nerve damage after perineural administration of a mixture of lidocaine and adrenaline [ 11 ]. It should be remembered, however, that adrenaline may potentiate the vasoconstrictor effect, especially in relation to long-acting LAs, thus prolonging the toxic effect of LA on axons [ 12 , 13 ].…”

Section: Adrenalinmentioning

confidence: 99%

Adjuvants in peripheral nerve blocks – the current state of knowledge

Gola¹,

Zając²,

Cugowski³

2020

ait

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Regional anaesthetic techniques are an essential element in acute and postoperative pain management [1]. Perineural deposition of a local anaesthetic leads to reversible blockade of sodium channels and temporary inhibition of nociceptive conduction. Nerve conduction blockade is based on the all-ornone law; hence, regional anaesthesia is the most efficacious form of analgesia. The benefits of regional analgesic techniques are particularly noticeable in trauma-orthopaedic, large-joint reconstructive and thoracic surgical procedures (Table 1) [2]. Depending on the local anaesthetic (LA) used, the duration of analgesia is limited to a maximum of 12-16 hours. For most scheduled procedures (usually performed between 8 a.m. and 3 p.m.), the blocking effect ends in the late evening or night [3, 4]. In most departments, compared to daytime, night hours are associated with a smaller staffing of medical personnel who can respond quickly to pain reported by the patient, which creates a risk of lack of optimal pain control. The imperative in the treatment of postoperative pain is to provide the patient with optimal analgesia and comfort, especially during the period of the most severe complaints, i.e. on the first postoperative day, including night hours. Hence, many techniques are used in clinical practice to prolong standard analgesia after perineural deposition of LA. These techniques include: • continuous nerve/plexus block followed by an infusion of a local anaesthetic,

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“…However, studies have shown that local anesthetics administered intrathecally may induce cell swelling, atrophy, edema, axonal degeneration, the appearance of myelin ovoid’s, and macrophage infiltration, 1 and continuous application of not only high concentrations but also normal clinical doses 2 of local anesthetics can cause neurotoxicity. 3 , 4 , 5 Although the potential neurotoxicity of local anesthetics has been investigated for many years, the mechanisms by which they induce neuronal injury are not fully understood. Therefore, it is necessary to identify these mechanisms to develop effective clinical strategies with which to prevent adverse outcomes after local anesthetic administration.…”

Section: Introductionmentioning

confidence: 99%

Autophagy activation attenuates the neurotoxicity of local anesthetics by decreasing caspase-3 activity in rats

Xue¹,

Lv²,

Leng³

et al. 2020

Brazilian Journal of Anesthesiology (English Edition)

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Epinephrine Administered With Lidocaine Solution Does Not Worsen Intrathecal Lidocaine Neurotoxicity in Rats

Abstract: Intrathecal epinephrine prolonged the action of intrathecal lidocaine but did not worsen lidocaine-induced histological damage and functional impairment.

Cited by 7 publications

References 22 publications

Epinephrine and Dexamethasone as Adjuvants in Upper Extremity Peripheral Nerve Blocks in Pediatric Patients

Epinephrine and Dexamethasone as Adjuvants in Upper Extremity Peripheral Nerve Blocks in Pediatric Patients

Adjuvants in peripheral nerve blocks – the current state of knowledge

Autophagy activation attenuates the neurotoxicity of local anesthetics by decreasing caspase-3 activity in rats

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