Study on Epinephrine Used in Local Anesthesia Controversy and certainty

Abstract

Epinephrine (adrenaline) - C9H13NO3 - was synthesized for the first time by Fredrich Stelz in 1904 from phenylalanine. After a hydrolysis and decarboxylation process, active dopamine is obtained. Following the pathway of other hydroxylation followed by N-methylation, epinephrine synthesis is achieved. Epinephrine has initially been administrated together with procaine in local anesthesia in hand surgery. Epinephrine has been considered to be one of causes of ischemia and necrosis in hand and especially fingers surgery. Over time, studies have shown the efficacy and safety of using lidocaine-associated epinephrine in local hand surgery anesthesia. Numerous advantages regarding the use of lidocaine 1% with epinephrine, solution at a concentration of 1:100,000 have been reported, starting with increasing the duration of anesthesia, avoiding the use of tourniquet, leading to increased patient comfort and to the advantage of a much lower cost in terms of surgery as a whole. Our study group consisted of fifty patients with hand and fingers different patologies. In all cases surgery was performed under local anesthesia using lidocaine 1% with epinephrine, solution at a concentration of 1:100,000. The decrease of doses mentioned in the literature was attempted and in some cases the decrease was up to 30%. There have not been reported any ischemic or necrosis complication in the immediate postoperative period.

Effectiveness and Safety of Wide Awake Local Anesthesia no Tourniquet (WALANT) Technique in Hand Surgery

“…In order to attenuate injection pain, Lalonde in 2014 and Petro Jose Pires Neto in 2017 suggested to buffer the anesthetic solution with 8.4% sodium bicarbonate in a 10:1 dilution,warming the anesthetic solution to body temperature, using smallergauge needles, perpendicular injection technique, and slow injection after previously creating pressure on the injection area [17,18]. We used thin injection needles in all study cases, respecting the needle size and injection method, but ice was placed on the insertion site for 30 seconds-1 minute prior to injectionto minimize injection pain.In no case was the anesthetic solution buffered with 8.4% sodium bicarbonate [19]. Using this technique patient comfort during the injection was good.…”

Open Carpal Tunnel Release:Performed Axillary Brachial Plexus Block vs. Wide Awake

“…We inject 20 mL of 1% lidocaine (C 14 H 22 N 2 O) with 1:100,000 epinephrine: 10 mL in the wrist between the median and ulnar nerves, and 10 mL in the palm. Lidocaine is a water-soluble and temperature stable substance being the most frequently used topical anaesthetic [11]. Due to the fact that the time to maximal vasoconstriction after injection is 25 min, to reduce the surgery time, we used the arm tourniquet.…”

Mepivacaine Hydrochloride - an Efficient Local Anesthetic Solution for the Electroresection of the Benign and Preneoplastic Lesions of the Cervix and Uterus

“…Mepivacaine proved thus an efficient anesthetic in curative procedures in gynecology and not only in diagnostic procedures as it was used before, in hysterosalpingography for infertility [15], proving a similar effect with that of lidocaine with epinephrine [16,17].…”