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.