The effect of adjuvant epinephrine concentration on the vasoactivity of the local anesthetics bupivacaine and levobupivacaine in human skin

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    Abstract

    The recommended optimal concentration of adjuvant epinephrine for use with local infiltration anesthesia is usually 5 µg/mL. However, a lower dose might be as effective at prolonging the anesthetic effects, while limiting the risk of hazards associated with unintentional intravascular injection. The aim of our study was to determine the lowest effective vasoconstrictor concentration of epinephrine in human skin for a range of doses of bupivacaine and its less-vasodilatory S(-) isomer, levobupivacaine. We injected combinations of 0.125%, 0.25%, and 0.75% bupivacaine and levobupivacaine with 1.25, 2.5, and 5 µg/mL epinephrine into the forearm skin of 10 healthy volunteers and measured the resulting blood flow changes over 1 hour using laser Doppler imaging. All 3 concentrations of epinephrine produced marked vasoconstriction, both alone and in combination with all 3 doses of the anesthetics (P < .001 in all cases). There was almost no difference in effect between the 3 epinephrine concentrations. We conclude that 1.25 µg/mL epinephrine produces a comparable vasoconstrictor effect in human skin to that of higher concentrations when coinjected with clinical doses of bupivacaine and levobupivacaine and may be equally effective for infiltration anesthesia.
    Original languageEnglish
    Pages (from-to)307-311
    Number of pages5
    JournalRegional Anesthesia and Pain Medicine
    Volume29
    Issue number4
    DOIs
    Publication statusPublished - 2004
    EventScottish Society for Experimental Medicine - Edinburgh, United Kingdom
    Duration: 22 Nov 200222 Nov 2002

    Fingerprint

    Bupivacaine
    Local Anesthetics
    Epinephrine
    Skin
    Local Anesthesia
    Vasoconstrictor Agents
    Anesthetics
    Vasoconstriction
    Forearm
    levobupivacaine
    Healthy Volunteers
    Lasers
    Injections

    Cite this

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    title = "The effect of adjuvant epinephrine concentration on the vasoactivity of the local anesthetics bupivacaine and levobupivacaine in human skin",
    abstract = "The recommended optimal concentration of adjuvant epinephrine for use with local infiltration anesthesia is usually 5 µg/mL. However, a lower dose might be as effective at prolonging the anesthetic effects, while limiting the risk of hazards associated with unintentional intravascular injection. The aim of our study was to determine the lowest effective vasoconstrictor concentration of epinephrine in human skin for a range of doses of bupivacaine and its less-vasodilatory S(-) isomer, levobupivacaine. We injected combinations of 0.125{\%}, 0.25{\%}, and 0.75{\%} bupivacaine and levobupivacaine with 1.25, 2.5, and 5 µg/mL epinephrine into the forearm skin of 10 healthy volunteers and measured the resulting blood flow changes over 1 hour using laser Doppler imaging. All 3 concentrations of epinephrine produced marked vasoconstriction, both alone and in combination with all 3 doses of the anesthetics (P < .001 in all cases). There was almost no difference in effect between the 3 epinephrine concentrations. We conclude that 1.25 µg/mL epinephrine produces a comparable vasoconstrictor effect in human skin to that of higher concentrations when coinjected with clinical doses of bupivacaine and levobupivacaine and may be equally effective for infiltration anesthesia.",
    author = "Newton, {David J.} and McLeod, {Graeme A.} and Faisel Khan and Belch, {Jill J. F.}",
    year = "2004",
    doi = "10.1016/j.rapm.2004.04.011",
    language = "English",
    volume = "29",
    pages = "307--311",
    journal = "Regional Anesthesia and Pain Medicine",
    issn = "1098-7339",
    publisher = "Lippincott, Williams & Wilkins",
    number = "4",

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    TY - JOUR

    T1 - The effect of adjuvant epinephrine concentration on the vasoactivity of the local anesthetics bupivacaine and levobupivacaine in human skin

    AU - Newton, David J.

    AU - McLeod, Graeme A.

    AU - Khan, Faisel

    AU - Belch, Jill J. F.

    PY - 2004

    Y1 - 2004

    N2 - The recommended optimal concentration of adjuvant epinephrine for use with local infiltration anesthesia is usually 5 µg/mL. However, a lower dose might be as effective at prolonging the anesthetic effects, while limiting the risk of hazards associated with unintentional intravascular injection. The aim of our study was to determine the lowest effective vasoconstrictor concentration of epinephrine in human skin for a range of doses of bupivacaine and its less-vasodilatory S(-) isomer, levobupivacaine. We injected combinations of 0.125%, 0.25%, and 0.75% bupivacaine and levobupivacaine with 1.25, 2.5, and 5 µg/mL epinephrine into the forearm skin of 10 healthy volunteers and measured the resulting blood flow changes over 1 hour using laser Doppler imaging. All 3 concentrations of epinephrine produced marked vasoconstriction, both alone and in combination with all 3 doses of the anesthetics (P < .001 in all cases). There was almost no difference in effect between the 3 epinephrine concentrations. We conclude that 1.25 µg/mL epinephrine produces a comparable vasoconstrictor effect in human skin to that of higher concentrations when coinjected with clinical doses of bupivacaine and levobupivacaine and may be equally effective for infiltration anesthesia.

    AB - The recommended optimal concentration of adjuvant epinephrine for use with local infiltration anesthesia is usually 5 µg/mL. However, a lower dose might be as effective at prolonging the anesthetic effects, while limiting the risk of hazards associated with unintentional intravascular injection. The aim of our study was to determine the lowest effective vasoconstrictor concentration of epinephrine in human skin for a range of doses of bupivacaine and its less-vasodilatory S(-) isomer, levobupivacaine. We injected combinations of 0.125%, 0.25%, and 0.75% bupivacaine and levobupivacaine with 1.25, 2.5, and 5 µg/mL epinephrine into the forearm skin of 10 healthy volunteers and measured the resulting blood flow changes over 1 hour using laser Doppler imaging. All 3 concentrations of epinephrine produced marked vasoconstriction, both alone and in combination with all 3 doses of the anesthetics (P < .001 in all cases). There was almost no difference in effect between the 3 epinephrine concentrations. We conclude that 1.25 µg/mL epinephrine produces a comparable vasoconstrictor effect in human skin to that of higher concentrations when coinjected with clinical doses of bupivacaine and levobupivacaine and may be equally effective for infiltration anesthesia.

    U2 - 10.1016/j.rapm.2004.04.011

    DO - 10.1016/j.rapm.2004.04.011

    M3 - Article

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    VL - 29

    SP - 307

    EP - 311

    JO - Regional Anesthesia and Pain Medicine

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    ER -