The Effect of Subcutaneous Epinephrine Dosage on Blood Loss in Surgical Incisions

Abstract

BACKGROUND Epinephrine is commonly used in plastic and reconstructive surgeries to reduce the blood loss, and to achieveing the lowest and the most effective dosage of epinephrine can improve the results of the surgery. METHODS Thirty two rats were divided in four groups. Local injection of epinephrine solution (3 mL) with concentrations of 1:200,000, 1:400,000 and 1:1,000,000 was undertaken in three different groups; and the fourth group was the control in which 3 mL of normal saline was administered 15 minutes before making the incision. The bleeding amount was compared in these groups. RESULTS A significant difference in blood loss was noted between the control and other groups, but no significant difference was present between epinephrine concentrations of 1:200,000, 1:400,000 and 1:1,000,000. CONCLUSION Local injection of epinephrine solution was shown to reduce bleeding from surgical incisions, but the difference between various pinephrine concentrations was not significant. The use of the lowest concentration (1:1,000,000) was suggested to decrease epinephrine side effects.

Can trajectory nor‐epinephrine infiltration reduce blood loss during percutaneous nephrolithotomy? A double‐blinded randomized controlled trial

“…Yet, there was no consensus about the optimum dose and/or concentration of its use (concentration may range from 1:50 000 to 1:400 000). It can be infused locally, systematically or tamponade the operative bed with NE‐soaked gauzes with no significant associated AEs 9,11,22–24 …”

“…These studies concluded that there was a clinically and statistically positive effect of these agents on the reduction of blood loss related to surgery. In addition, these hemostatic agents are physiologically Justified when mindfully used 9,10,22,24,25 . Another interesting study led by Wuethrich et al.…”

“…It can be infused locally, systematically or tamponade the operative bed with NE-soaked gauzes with no significant associated AEs. 9,11,[22][23][24] The objective of this study was to investigate the effect of infiltration of NE during PCNL in the mitigation of perioperative blood loss. Our results revealed that; there was a significant difference in EBL between the two study groups (378 [252-504] versus 592 [378-756]; p > 0.001) in favor of the NE-PCNL group.…”

“…In addition, these hemostatic agents are physiologically Justified when mindfully used. 9,10,22,24,25 Another interesting study led by Wuethrich et al deduced that continuous NE infusion reduces blood loss, blood transfusion rate, and the number of transfused units required per patient who underwent radical cystectomy. 26 Furthermore, in a recently published study that included 120 patients who were divided into 2 groups, El-Shaer and his colleagues found that, patients whose PCNL trajectory infiltrated by a mixture of local anesthesia contained NE had a lower Hb drop as compared to patients of the control group whom their PCNL trajectory was not infiltrated by NE.…”

Office-based Blepharoplasty

“…With slow infiltration it is often the initial needle stick that is the only significant pain. Epinephrine concentration is decreased to 1:600,000. Epinephrine concentrations as low as 1:1,000,000 produce good vasoconstriction 10 . Both the local anesthetic dose and the epinephrine concentration are reduced such that the risk of epinephrine side effects is remote (tachycardia to any degree only VERY rarely happens), and the local anesthetic injected initially is a very modest amount, lessening the risk of anesthetic toxicity. A subsequent reinjection of full-strength local anesthetic is given in the exact same field into an already vasoconstricted and anesthetized bed, so there is little or no pain with reinjection and also no epinephrine side-effect.…”