The Effects of Different Concentrations of Epinephrine Adjuvant to Levobupivacaine on Wound Healing

Abstract

Objective: Local anesthetics (LAs) and epinephrine are often combined for infiltration of surgical sites for their wide-range effects. The aim of our study is to investigate the effects of different concentrations of epinephrine added to levobupivacaine on wound healing. Methods: Forty female albino Wistar rats were divided into four groups. 3 ml of 3,75mg/ml levobupivacaine was applicated for all groups. In the control group (C) (n=10), 1ml isotonic saline was added, and in group A10 (10 µg/ml) (n=10), 1ml 1/100,000 adrenaline; in group A5 (5 µg/ml) (n=10), 1ml 1/200,000 adrenaline; and in group A2,5 (2,5 µg/ml) (n=10), 1ml 1/400,000 adrenaline. Two minutes after the infiltration of the drug combination into subcutaneous tissue, 3cm longitudinal cutaneous-subcutaneous incisions were performed on the mid-dorsal line under sterile conditions. Incisions were sutured with 4/0 sharp prolen with six sutures. Postoperative 8th-day rats were sacrificed to evaluate wound healing. Tissue burst pressures (TBP) and tissue hydroxyproline levels (THP) were measured, and histopathological evaluation for a fibrotic index was performed. A One-Way ANOVA and Chi-square test were used for statistical analyses. Results: There was no statistically significant difference between groups according to TBP and THP levels (p=0.4, p=0.201 respectively). Fibrotic index values were significantly higher in epinephrine groups (p=0,001), and were highest in A2,5. Conclusions: Epinephrine added to levobupivacaine in low concentrations accelerates wound healing in the early phase by stimulating fibrosis, and has no adverse effects on surgical sites. Long-term studies are needed for late effects of epinephrine adjuvant levobupivacaine.