Applied pharmacology of local anesthetics

Bieter, Raymond N.

doi:10.1016/s0002-9610(36)90673-6

Cited by 39 publications

(10 citation statements)

References 19 publications

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“…There have been surprisingly few dose-duration studies of EPI as an adjuvant to local anesthetics, using different regional anesthetic techniques. In older studies, the duration of anesthesia following intradermal (34) or subconjuncti-Val (39) injections of ester-type local anesthetics was found to increase when EPI was included in concentrations up to 5 pg/ml, additional effects at higher concentrations being negligible. In more recent studies, using experimental peripheral nerve block techniques, only a few local anesthetics and EPI concentrations have been tested, and prolongation of anesthesia by up to 150% has been reported (12,34,(40)(41)(42).…”

Section: Discussionmentioning

confidence: 98%

“…In older studies, the duration of anesthesia following intradermal (34) or subconjuncti-Val (39) injections of ester-type local anesthetics was found to increase when EPI was included in concentrations up to 5 pg/ml, additional effects at higher concentrations being negligible. In more recent studies, using experimental peripheral nerve block techniques, only a few local anesthetics and EPI concentrations have been tested, and prolongation of anesthesia by up to 150% has been reported (12,34,(40)(41)(42). Investigating non-buffered solutions, Hassan et al (15) found the order of IONB-prolonging effect of including EPI at 5 pg/ml to be 2% prilocaine > 0.5% bupivacaine > 2% lidocaine and 0.5% etidocaine; thus the effect was unrelated to the physicochemical or anticipated vasoactive properties of the local anesthetics tested.…”

Section: Discussionmentioning

confidence: 98%

“…Also the effects of EPI show regional variations as therapeutic doses markedly reduce cutaneous blood flow but increase skeletal muscle blood flow (32). In more concentrated solutions, EPI tends to produce local ischemia and acidosis (33) "which hinders the continuance of the anesthesia'' (34). Nerve blood flow is synergistically reduced by lidocaine with EPI added at 5 pg/ml (35).…”

Section: Discussionmentioning

confidence: 99%

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Epinephrine as an adjuvant to amino‐amide local anesthetics does not prolong their duration of action in infraorbital nerve block in the rat

Renck

Hassan²

1992

Acta Anaesthesiol Scand

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The effects of epinephrine as an adjuvant to local anesthetics were studied in the rat infraorbital nerve block (IONB) model, using solutions of 0.5% prilocaine, 0.5% mepivacaine, 0.125% bupivacaine or 0.125% ropivacaine in 50 mmol/l tris-hydroxymethylaminomethane (THAM) tested both without and with epinephrine (EPI) added at 2, 4, 8 or 16 micrograms/ml. Solutions of THAM and EPI in normal saline did not induce IONB. THAM-buffered solutions of bupivacaine induced IONB of longer duration than bicarbonate-buffered solutions. Intensity of block during onset was increased only when EPI at 2 and 16 micrograms/ml was included in bupivacaine solutions. The duration of block induced by prilocaine, bupivacaine and ropivacaine was not significantly prolonged by addition of EPI at any of the concentrations tested. Only at a concentration of 16 micrograms/ml did EPI significantly prolong the duration of mepivacaine-induced block (+48%). Low concentrations of EPI in solutions of bupivacaine and ropivacaine significantly reduced their duration of action by up to 22% and 57%, respectively. It is concluded that the duration of action of local anesthetics in buffered solutions is only moderately affected by the inclusion of EPI, the effects differing only slightly from one to another. The efficacy of EPI as an adjuvant would seem to be governed by factors affecting the local disposition of the main drugs, such as non-specific binding, buffering of solutions and tissue pH.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Epinephrine as an adjuvant to amino‐amide local anesthetics does not prolong their duration of action in infraorbital nerve block in the rat

Renck

Hassan²

1992

Acta Anaesthesiol Scand

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“…The dose of adrenaline that is necessary to produce these effects is poorly understood. Bieter (1936) showed that for infiltration anaesthesia 1 : 200,000 adrenaline prolonged the action of procaine for the longest time, but 1 : 500,000 still provided good prolongation of anaesthesia (Table 2). In certain locations higher doses of adrenaline appear necessary, such as the oral mucosa.…”

Section: Endoscopic Surgerymentioning

confidence: 99%

Haemostasis in Urology: Mechanism and Pharmacology

Briggs

Parker

Anson

et al. 1992

British Journal of Urology

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“…The involvement of esterases in local anaesthesia was propounded by Bieter (21) because D.F.P. and eserine can abolish conduction without depolarization or transient excitation.…”

mentioning

confidence: 99%

The Mode of Action of Local Anaesthetics

Watson

1960

Journal of Pharmacy and Pharmacology

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'methods, and by the use of radioactive tracers: details are given by Hodgkin in his review (116), and also by Hodgkin anda Keynes (122). Most of this work was carried out upon squid tissue, and Keynes (139) has warned that it would be dangerous to assume that an identical series of events occurs during impulse conduction along other types of nerve and muscle fibres. Barlow, in 1955 (9), observed that, in a resting nerve, external sodium ions give a positive charge to the outside of¡ the cell (Boyle and Conway (26) demonstrated the same effect in muscle), but after stimulation the ionic positions are reversed with sodium inside and potassium outside. Unlike Gray and Geddes (91) who envisaged recovery as a restoration of the potassium balance by a form of pumping action, he was convinced that a dual problem exists, not merely that of getting potassium in, but also of sodium extrusion. If the modified Bernstein theory is true, the contention 'After the changes, the nerve fairly quickly returns to normal !and can conduct another impulse, the fibre having gained a small quantity of sodium and having lost a similar one of potassium. The ionic movements are the immediate energy source for impulse conduction, and are reversed later by a Gti[aiJ1O0TE 'SS6'L 'H`LUUliag s

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Applied pharmacology of local anesthetics

Cited by 39 publications

References 19 publications

Epinephrine as an adjuvant to amino‐amide local anesthetics does not prolong their duration of action in infraorbital nerve block in the rat

Epinephrine as an adjuvant to amino‐amide local anesthetics does not prolong their duration of action in infraorbital nerve block in the rat

Haemostasis in Urology: Mechanism and Pharmacology

The Mode of Action of Local Anaesthetics

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