Epinephrine and alpha 2 agonist drugs are often used with epidural anesthesia to minimize local anesthetic systemic absorption, as well as to prolong the duration of the block. The aim of the current study was to determine by which extent epinephrine and medetomidine influenced lidocaine systemic absorption rate following epidural application. This was achieved by monitoring the serum lidocaine concentration in a porcine model. During general anesthesia, the first group received epidurally plane lidocaine, the second received lidocaine containing epinephrine (1 : 80.000), and the third lidocaine with medetomidine (15 μg/kg). Venous blood samples were taken before and 5, 10, 20, 30, 45, 60 and 90 minutes following epidural administration of the anesthetic. The effects of epinephrine and medetomidine were comparable. They both failed to cause a significant decrease in serum lidocaine concentration (p>0.05). In these settings we were unable to demonstrate a greater capacity of these two adrenergic agonists for reducing lidocaine systemic uptake and, accordingly, its systemic toxicity potential.
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1. Vnuk D Nesek-Adam V Pecin M Musulin A Lemo N Brajenovic N Brcic Karaconji I Radisic B Smolec O Lipar M: Hemodynamic effects of epidural lidocaine vs lidocaine - adrenaline in dogs. Vet arhiv 2011 81: 585-595.
2. Habibian S Bigham AS Aali E: Comparison of lidocaine tramadol and lidocaine-tramadol for epidural analgesia in lambs. Res Vet Sci 2011 3: 434-438.
3. Jones RS: Epidural analgesia in the dog and cat. Vet J 2001 161: 123-131.
4. Bernards CM Kopacz DJ: Effect of adrenaline on lidocaine clearance in vivo. Anesthesiology 1999 91: 962-968.
6. Lubenow TR Ivankovich AD Barkin RL: Management of acute postoperative pain. In: Barash PG Cullen BF Stoelting RK (Eds.). Clinical Anesthesia. Lippincott Williams & Wilkins Philadelphia USA IV edition 2002 1405-1437.
7. Clement R Malinowsky J-M Le Corre P Dollo G Chevanne F Le Verge R: Cerebrospinal fluid bioavailability and pharmacokinetics of bupivacaine and lidocaine after intrathecal and epidural administration in rabbits using microdialysis. J Pharmacol Exp Ther 1999 289: 1015-1021.
8. Jamous MA Hand CW Moore RA Teddy PJ McQuay HJ: Epinephrine reduces systemic absorption of extradural diacetylmorphine. Anesthesia & Analgesia 1986 65: 1290-1294.
9. Brose WG Cohen SE: Epidural lidocaine for cesarean section: effect of varying epinephrine concentration. Anesthesiology 1988 69: 936-940.
10. Curatolo M Petersen-Felix S Arendt-Nielsen L Zbinden AM: Epidural epinephrine and clonidine: segmental analgesia and effects on different pain modalities. Anesthesiology 1997 87: 785-794.
11. Niemi G Breivik H: Epinephrine markedly improves thoracic epidural analgesia produced by a small -dose infusion of ropivacaine fentanyl and epinephrine after major thoracic or abdominal surgery: a randomized double -blinded crossover study with and without epinephrine. Anesthesia & Analgesia 2002 94: 1598-1605.
12. Singh V Amarpal Kinjavdekar P Aithal HP Pratap K: Medetomidine with ketamine and bupivacaine for epidural analgesia in buffaloes. Vet Res Comm 2005 29: 1-18.
13. Liu SS Lin Y: Local anesthetics. In: Clinical Anesthesia. Barash PG Cullen BF Stoelting RK Cahalan MK Stock CM (Eds.). Lippincott Williams & Wilkins Philadelphia USA VI edition 2009 531-547.
14. Ohno H Watanabe M Saitoh J Saegusa Y Hasegawa Y Yonezawa T: Effect of epinephrine concentration on lidocaine disposition during epidural anesthesia. Anesthesiology 1988 68: 625-628.
15. Mazoit JX Benhamou D Veillette Y Samii K: Clonidine and or adrenaline decrease lignocaine plasma peak concentration after epidural injection. Br J Clin Pharmacol 1996 42: 242-245.
16. Bernards C: Epidural and spinal anesthesia. In: Clinical Anesthesia. Barash PG Cullen BF Stoelting RK Cahalan MK Stock CM (Eds.). Lippincott Williams & Wilkins Philadelphia USA VI edition 2009 927-954.
17. Nishikawa T Dohi S: Clinical evaluation of clonidine added to lidocaine solution for epidural anesthesia. Anesthesiology 1990 73: 853-859.
18. Ohshima T Takayasu T: Simultaneous determination of local anesthetics including estertype anesthetics in human plasma and urine by gas chromatography-mass spectrometry with solid-phase extraction. J Chromatogr B Biomed Sci Appl 1999 726: 185-194.
19. Rostami M Vesal N: The effects of adding epinephrine or xylazine to lidocaine solution for lumbosacral epidural analgesia in fat-tailed sheep. JSAVA 2012 http://dx.doi.org/10.4102/ jsava.v83i1.1.
20. Durej M Ledecký V Michalák D Hluchý M Kòazovický D: Efficacy of epidural administration of morphine with bupivacaine for orthopaedic surgery in sheep. Acta Vet (Beograd) 2012 62: 111-119.
21. Johnson JO Grecu L Lawson NW: Autonomic nervous system. In: Clinical Anesthesia. Barash PG Cullen BF Stoelting RK Cahalan MK Stock CM (Eds.). Lippincott Williams & Wilkins Philadelphia USA VI edition 2009 326-368.
22. Virtanen R Savola JM Saano V Nyman L: Characterization of the selectivity specificity and potency medetomidine as an alpha 2-adrenoceptor agonist. Eur J Pharm 1988 150; 9-14.
23. Hall LW Clarke KW: Veterinary Anaesthesia. WB Saunders London UK IX edition 1991 58-63.
24. Hellyer PW Robertson SA Fails AD: Pain and its management. In: Lumb & Jones’ veterinary anesthesia and analgesia. Tranquilli WJ Thurmon JC Grimm KA (Eds.). Blackwell Publishing Iowa USA V edition 2007 31-57.
25. Lemke KA: Anticholinergics and sedatives. In: Lumb & Jones’ veterinary anesthesia and analgesia. Tranquilli WJ Thurmon JC Grimm KA (Eds.). Blackwell Publishing Iowa USA V edition 2007 203-239.
26. Sharrock NE Go G Mineo R: Effect of i.v. low -dose adrenaline and phenylephrine infusions on plasma concentrations of bupivacaine after lumbar extradural anesthesia in elderly patients. Br J Anesth 1991 67: 694-698.
27. Saikh MI: Autonomic nervous system. In: Basics of anesthesia. Stoelting RK Miller RD (Eds.). Elsevier Churchill Livingstone Philadelphia USA V edition 2007 64-76.
28. Salevsky FC Whalley DG Kalant D Crawhall J: Epidural epinephrine and the systemic circulation during peripheral vascular surgery. Can J Anesth 1990 37: 160-165.