Vasoactive characteristics of bupivacaine and levobupivacaine with and without adjuvant epinephrine in peripheral human skin

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    Abstract

    Background. Epinephrine is added to local anaesthetic preparations to prolong their action and reduce their systemic absorption. Bupivacaine and levobupivacaine cause vasodilatation at clinical doses, but lower doses appear to cause vasoconstriction. The aim of this study was to characterize fully the vasoactive effects of these anaesthetics, using an objective measure of blood flow, and to assess the influence of adding epinephrine.

    Methods. Laser Doppler imaging was used to measure the forearm skin blood flow responses to intradermal injection of eight doses of bupivacaine and levobupivacaine in 10 healthy male volunteers. The doses tested ranged from 0.008% to 0.75%, and the five highest doses were administered both with and without adjuvant epinephrine 2.5 µg ml-1.

    Results. The cumulative responses to the lower subclinical concentrations (0.008–0.0625%) of both anaesthetics were smaller than or similar to that produced by saline alone, indicating a net vasoconstrictive effect. Higher doses caused net vasodilatation, and the levobupivacaine responses were generally lower than the corresponding bupivacaine responses (P=0.022). Epinephrine 2.5 µg ml-1 significantly reduced the responses to clinical doses of both drugs (P<0.001), producing net vasoconstriction.

    Conclusions. Bupivacaine and levobupivacaine have a biphasic vascular effect when injected intradermally, with subclinical doses causing net vasoconstriction. The addition of epinephrine 2.5 µg ml-1 decreases these responses markedly.
    Original languageEnglish
    Pages (from-to)662-667
    Number of pages6
    JournalBRITISH JOURNAL OF ANAESTHESIA
    Volume94
    Issue number5
    DOIs
    Publication statusPublished - 2005

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    Bupivacaine
    Epinephrine
    Skin
    Vasoconstriction
    Vasodilation
    Anesthetics
    Intradermal Injections
    Local Anesthetics
    Forearm
    Blood Vessels
    Healthy Volunteers
    Lasers
    levobupivacaine
    Pharmaceutical Preparations

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    @article{bf4f48b5ef514b068248678180250072,
    title = "Vasoactive characteristics of bupivacaine and levobupivacaine with and without adjuvant epinephrine in peripheral human skin",
    abstract = "Background. Epinephrine is added to local anaesthetic preparations to prolong their action and reduce their systemic absorption. Bupivacaine and levobupivacaine cause vasodilatation at clinical doses, but lower doses appear to cause vasoconstriction. The aim of this study was to characterize fully the vasoactive effects of these anaesthetics, using an objective measure of blood flow, and to assess the influence of adding epinephrine.Methods. Laser Doppler imaging was used to measure the forearm skin blood flow responses to intradermal injection of eight doses of bupivacaine and levobupivacaine in 10 healthy male volunteers. The doses tested ranged from 0.008{\%} to 0.75{\%}, and the five highest doses were administered both with and without adjuvant epinephrine 2.5 µg ml-1.Results. The cumulative responses to the lower subclinical concentrations (0.008–0.0625{\%}) of both anaesthetics were smaller than or similar to that produced by saline alone, indicating a net vasoconstrictive effect. Higher doses caused net vasodilatation, and the levobupivacaine responses were generally lower than the corresponding bupivacaine responses (P=0.022). Epinephrine 2.5 µg ml-1 significantly reduced the responses to clinical doses of both drugs (P<0.001), producing net vasoconstriction.Conclusions. Bupivacaine and levobupivacaine have a biphasic vascular effect when injected intradermally, with subclinical doses causing net vasoconstriction. The addition of epinephrine 2.5 µg ml-1 decreases these responses markedly.",
    author = "Newton, {D. J.} and McLeod, {G. A.} and F. Khan and Belch, {J. J. F.}",
    year = "2005",
    doi = "10.1093/bja/aei095",
    language = "English",
    volume = "94",
    pages = "662--667",
    journal = "British Journal of Anaesthesia",
    issn = "0007-0912",
    number = "5",

    }

    TY - JOUR

    T1 - Vasoactive characteristics of bupivacaine and levobupivacaine with and without adjuvant epinephrine in peripheral human skin

    AU - Newton, D. J.

    AU - McLeod, G. A.

    AU - Khan, F.

    AU - Belch, J. J. F.

    PY - 2005

    Y1 - 2005

    N2 - Background. Epinephrine is added to local anaesthetic preparations to prolong their action and reduce their systemic absorption. Bupivacaine and levobupivacaine cause vasodilatation at clinical doses, but lower doses appear to cause vasoconstriction. The aim of this study was to characterize fully the vasoactive effects of these anaesthetics, using an objective measure of blood flow, and to assess the influence of adding epinephrine.Methods. Laser Doppler imaging was used to measure the forearm skin blood flow responses to intradermal injection of eight doses of bupivacaine and levobupivacaine in 10 healthy male volunteers. The doses tested ranged from 0.008% to 0.75%, and the five highest doses were administered both with and without adjuvant epinephrine 2.5 µg ml-1.Results. The cumulative responses to the lower subclinical concentrations (0.008–0.0625%) of both anaesthetics were smaller than or similar to that produced by saline alone, indicating a net vasoconstrictive effect. Higher doses caused net vasodilatation, and the levobupivacaine responses were generally lower than the corresponding bupivacaine responses (P=0.022). Epinephrine 2.5 µg ml-1 significantly reduced the responses to clinical doses of both drugs (P<0.001), producing net vasoconstriction.Conclusions. Bupivacaine and levobupivacaine have a biphasic vascular effect when injected intradermally, with subclinical doses causing net vasoconstriction. The addition of epinephrine 2.5 µg ml-1 decreases these responses markedly.

    AB - Background. Epinephrine is added to local anaesthetic preparations to prolong their action and reduce their systemic absorption. Bupivacaine and levobupivacaine cause vasodilatation at clinical doses, but lower doses appear to cause vasoconstriction. The aim of this study was to characterize fully the vasoactive effects of these anaesthetics, using an objective measure of blood flow, and to assess the influence of adding epinephrine.Methods. Laser Doppler imaging was used to measure the forearm skin blood flow responses to intradermal injection of eight doses of bupivacaine and levobupivacaine in 10 healthy male volunteers. The doses tested ranged from 0.008% to 0.75%, and the five highest doses were administered both with and without adjuvant epinephrine 2.5 µg ml-1.Results. The cumulative responses to the lower subclinical concentrations (0.008–0.0625%) of both anaesthetics were smaller than or similar to that produced by saline alone, indicating a net vasoconstrictive effect. Higher doses caused net vasodilatation, and the levobupivacaine responses were generally lower than the corresponding bupivacaine responses (P=0.022). Epinephrine 2.5 µg ml-1 significantly reduced the responses to clinical doses of both drugs (P<0.001), producing net vasoconstriction.Conclusions. Bupivacaine and levobupivacaine have a biphasic vascular effect when injected intradermally, with subclinical doses causing net vasoconstriction. The addition of epinephrine 2.5 µg ml-1 decreases these responses markedly.

    U2 - 10.1093/bja/aei095

    DO - 10.1093/bja/aei095

    M3 - Article

    C2 - 15722384

    VL - 94

    SP - 662

    EP - 667

    JO - British Journal of Anaesthesia

    JF - British Journal of Anaesthesia

    SN - 0007-0912

    IS - 5

    ER -