Effects of epinephrine in local anesthetics on the central and peripheral nervous systems: Neurotoxicity and neural blood flow

Neal, Joseph M.

doi:10.1053/rapm.2003.50024

Cited by 86 publications

(91 citation statements)

References 95 publications

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“…Reducing the dose, concentration, or potency of local anesthetic, or eliminating or reducing the concentration of vasoconstrictive additives are potential considerations, based on moderately extensive animal data. 17,23 Limited human data neither support nor refute this recommendation. The diagnosis and prognosis of peripheral nerve injury largely depends on the severity of symptoms upon presentation.…”

Section: Peripheral Injuriesmentioning

confidence: 99%

“…There are no human data to support diminution of SCBF from vasoconstrictors such as epinephrine. 23 Spinal cord blood supply can be tenuous, particularly to the anterior cord and the lower thoracic and lumbosacral segments. Although mechanical damage to the arterius radicularis magnus could compromise spinal cord circulation, this vessel and the anterior spinal artery system are quite distant from needles used for neuraxial and perineuraxial pain procedures.22 However, transforaminal approaches may have a higher potential for encountering major spinal arteries as they traverse the intervertebral foramen.…”

Section: Pathophysiology Of Neuraxial Injurymentioning

confidence: 99%

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ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine

Neal¹,

Bernards²,

Hadžić³

et al. 2008

Regional Anesthesia and Pain Medicine

238

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Neurologic complications associated with regional anesthesia and pain medicine practice are extremely rare. The ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine addresses the etiology, differential diagnosis, prevention, and treatment of these complications. This Advisory does not focus on hemorrhagic and infectious complications, because they have been addressed by other recent ASRA Practice Advisories. The current Practice Advisory offers recommendations to aid in the understanding and potential limitation of neurologic complications that may arise during the practice of regional anesthesia and pain medicine. KeywordsComplications of anesthesia; Nerve injury; Spinal anesthesia; Epidural anesthesia; Peripheral nerve block; Regional anesthesia; Pain medicine; Transforaminal block The American Society of Regional Anesthesia and Pain Medicine (ASRA) convened a group of experts to develop a Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine. The goal of this Practice Advisory is to provide information for practitioners of regional anesthesia and pain medicine regarding the etiology, differential diagnosis, prevention, and treatment of neurologic complications. This Practice Advisory focuses on neurologic injuries apart from those caused by hemorrhagic 1 or infectious2 -6 complications, both of which have been the subject of other recent ASRA-sponsored Practice Advisories. The current report is a summation of the Practice Advisory's findings and recommendations. Anesthesiologists are strongly encouraged to read the manuscripts that accompany the present summary document, because they contain the details upon which recommendations are based. The accompanying manuscripts represent most of the subtopics discussed at the conference. The recommendations contained within this Practice Advisory represent the opinions of a small group of expert panelists and are based upon their clinical experience, review of limited scientific literature (anatomic and physiologic studies of animals and human cadavers, case reports, retrospective case series, and non-randomized trials), and open forum discussion. Importantly, in this imperfect setting of controversial topics, limited data, and bias inherent to expert opinion, the Panel consistently tended towards making conservative recommendations. We acknowledge that other experts analyzing the same information may arrive at recommendations different than ours. The recommendations contained herein are not intended to define standard practice or to ensure the avoidance of adverse outcomes. Furthermore, the recommendations are subject to change as new information becomes available. Recommendations from the Practice Advisory are not intended to replace clinical judgment, and specific risk-to-benefit discussions as they pertain to individual patients.Because neurologic injuries related to anesthesia and pain medicine practice are extremely rare, standard tools of evidence-based medicine such as randomized c...

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Section: Peripheral Injuriesmentioning

confidence: 99%

Section: Pathophysiology Of Neuraxial Injurymentioning

confidence: 99%

ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine

Neal¹,

Bernards²,

Hadžić³

et al. 2008

Regional Anesthesia and Pain Medicine

238

View full text Add to dashboard Cite

show abstract

“…However, a contribution of vasoconstriction to peripheral nerve injury has not been proved, and clinical observations suggest that this aspect of toxicity generally plays a minor role. 32 For instance, peripheral nerves are tolerant to full ischemia from the use of an occlusive tourniquet for hours (see below). Nonetheless, in the context of predisposing factors such as diabetes or peripheral vascular disease, it is prudent to add epinephrine to local anesthetic solutions only if prolongation of the block cannot be achieved by use of a different local anesthetic, or if maximal doses are used and systemic toxicity is possible.…”

Section: Toxicity Of Injected Solutionmentioning

confidence: 99%

Pathophysiology of Peripheral Nerve Injury During Regional Anesthesia

Hogan¹

2008

Regional Anesthesia and Pain Medicine

130

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“…Normeperidine accumulation was not noted in patients of either study group during the 48-hr study period. Epidural adrenaline is believed to promote prolonged and enhanced activity of both local anesthetics 15 and opioids 12 by increasing the mass of drug at the spinal cord and roots. Adrenaline may have analgesic properties of its own, acting through α 2 -adrenergic receptors in the spinal cord, and has been shown independently to produce segmental hypoalgesia in healthy volunteers.…”

Section: Discussionmentioning

confidence: 99%

L’ajout d’adrénaline à la mépéridine péridurale thoracique n’améliore pas l’analgésie à la suite d’une thoracotomie

Bryson

Thompson

Gagne

et al. 2007

Can J Anesth/J Can Anesth

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Purpose: Patient-controlled epidural analgesia (PCEA) with meperidine provides effective analgesia following thoracotomy. Accumulation of normeperidine, a meperidine metabolite with neuroexcitatory effects, has led to recommendations to limit the use of meperidine postoperatively. The purpose of this study was to determine if the addition of adrenaline to PCEA meperidine decreased meperidine consumption, reduced serum normeperidine levels, and improved analgesia following thoracotomy.Methods: Following Research Ethics approval consenting patients were randomly assigned to PCEA with either meperidine (2 mg·mL -1 ) + adrenaline (2 µg·mL -1 ) or meperidine alone (2 mg·mL -1 ). All patients received a standardized anesthetic and similar perioperative care. Visual analogue pain scores (at rest and with activity), quality of recovery (QoR) scores, and side effects were documented six, 24, and 48 hr postoperatively. Serum levels of meperidine and normeperidine were measured at the same time points.Results: Forty-six patients completed the study protocol. Meperidine consumption (mean ± SD) was similar in the meperidine + adrenaline and the meperidine groups (601 ± 211 mg vs 580 ± 211 mg over 48 hr, respectively; P = 0.744). Serum meperidine levels were similar at all study time points. Serum normeperidine was not detected in any sample. Pain scores, QoR scores, and adverse events were comparable in both study groups. Conclusion:The addition of adrenaline did not influence PCEA meperidine consumption, analgesia outcomes, or QoR. Normeperidine did not accumulate in patients of either study group during the 48-hr study period. Meperidine for patientcontrolled epidural analgesia, with or without adrenaline, provides effective post-thoracotomy analgesia in selected patients.

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Effects of epinephrine in local anesthetics on the central and peripheral nervous systems: Neurotoxicity and neural blood flow

Cited by 86 publications

References 95 publications

ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine

ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine

Pathophysiology of Peripheral Nerve Injury During Regional Anesthesia

L’ajout d’adrénaline à la mépéridine péridurale thoracique n’améliore pas l’analgésie à la suite d’une thoracotomie

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