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소장정보 검색

국회도서관 홈으로 정보검색 소장정보 검색
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Title Page

Contents

Abstract 10

Introduction 13

Methods 15

Results 18

1. Effect of epinephrine on local cutaneous blood flow: Lowest dosage required to achieve vasoconstriction 18

2. The onset of vasoconstriction following the local infiltration of lidocaine with epinephrine 21

3. Effect of epinephrine on the duration for vasoconstriction 27

4. Effect of epinephrine on the duration of local anesthesia 33

5. Ratio used for the alkalization of lidocaine with epinephrine 39

6. Pain according to the alkalized mixture of lidocaine with epinephrine and sodium bicarbonate 41

7. Maximum safe dosage of lidocaine with or without epinephrine 43

Discussion 44

Conclusion 57

References 58

List of Tables

Table 1. Effective concentrations of epinephrine to cause vasoconstriction in each site 19

Table 2. Effective epinephrine concentrations for vasoconstrictive effect 20

Table 3. Onset of vasoconstriction caused by the usage of lidocaine with epinephrine in each site 24

Table 4. Onset of vasoconstriction caused by the usage of lidocaine with epinephrine 25

Table 5. Duration of vasoconstriction caused by the usage of lidocaine with epinephrine in each site 29

Table 6. Duration of vasoconstriction caused by the usage of lidocaine with epinephrine 30

Table 7. Duration of local anesthesia caused by the usage of lidocaine with epinephrine in each site 35

Table 8. Duration of local anesthesia caused by the usage of lidocaine with epinephrine 36

Table 9. Alkalization of local anesthetic solution 40

Table 10. Pain score according to the use of a buffered or an unbuffered solution 42

Table 11. Comparison between skin thickness and onset of vasoconstriction... 49

List of Figures

Figure. 1. Flow chart of the selection process for the papers included in this review. 17

Figure. 2. Onset of vasoconstriction caused by the usage of lidocaine with... 26

Figure. 3. Duration of vasoconstriction caused by the usage of lidocaine with... 31

Figure. 4. Linear regression model of duration of vasoconstriction caused by the... 32

Figure. 5. Duration of local anesthesia caused by the usage of lidocaine with... 37

Figure. 6. Linear regression model of duration of local anesthesia caused by the... 38

초록보기

 The aim of this study is to assess the effect of lidocaine adjuvant with epinephrine in plastic surgical field by reviewing the existing literatures systematically.

In a search of PubMed, Embase, and the Cochrane Library, the search terms "lidocaine" AND "epinephrine" AND "plastic surgery" were used. Among the 226 titles (PubMed, 150 titles; Embase, 65 titles; Cochrane Library, 11 titles), 25 duplicate titles were excluded and 201 titles were reviewed. Among the 201 titles, 77 were excluded, and 124 abstracts were reviewed. Among the 124 abstracts, 102 abstracts were excluded, and 22 full articles which evaluate epinephrine and lidocaine were reviewed. Among the 22 full articles, 10 were excluded, and 10 externally identified papers were added. Ultimately, 22 papers were reviewed.

Concentrations between 1:50,000 and 1:400,000 have been found to be equally effective, yielding superior vasoconstriction compared with more dilute solutions, although 1:800,000 and 1:1,000,000 concentrations of epinephrine can also cause vasoconstriction. The mean time for the onset of maximum vasoconstriction caused by lidocaine with epinephrine ranged from 1.3 minutes (with 1:50,000 epinephrine) to 25.9 minutes (with 1:100,000 epinephrine). The mean duration of vasoconstriction caused by lidocaine with epinephrine ranged from 40 minutes (with 1:100,000 epinephrine) to 136.7 minutes (with 1:50,000 epinephrine) on the forearm, and was 60 minutes (with 1:100,000 and 1:200,000 epinephrine) on the face. In the forearm, the more diluted the epinephrine was, the shorter its duration of vasoconstriction (y＝-(4.502×10-5)x+120.785, p-value＝0.008). The mean duration of local anesthesia ranged from 112.0 minutes (with 1:1,600,000 epinephrine) to 480 minutes (with 1:80,000 epinephrine). In the forearm, the more diluted the epinephrine was, the shorter its duration of vasoconstriction (with 0.5% lidocaine, y＝-(1.124×10-4)x+327.138, p-value: 0.007; with 1.0% lidocaine, y＝-(1.667×10-4)x+352.396, p-value: 0.008; with y＝-(1.887×10-4)x+391.271, p-value: 0.002) Before sodium bicarbonate was mixed with 1% lidocaine and 1:100,000 concentration of epinephrine, the mean pH ranged from 4.05 to 4.24. After mixing sodium bicarbonate with 1% lidocaine and 1:100,000 concentration of epinephrine, the solution became alkalized, and the mean pH ranged from 7.05 to 7.66. For alkalization, the ratio of lidocaine with epinephrine to sodium bicarbonate was 9:1 to 10:1. Before alkalization (unbuffered) of the lidocaine with epinephrine, the mean pain score ranged from 2.35 to 7.6. In contrast, after alkalizing the mixture by adding 8.4% sodium bicarbonate (buffered), the mean pain score ranged from 0.64 to 4.3. With slow injection rate in the soft tissue, the maximum safe dose of lidocaine is approximately 3 mg/kg plain (0.3 ml/kg for 0.1% lidocaine) and 7 mg/kg (0.7 ml/kg for 0.1% lidocaine) when mixed with epinephrine.

In conclusion, 1:100,000 or 1:200,000 concentrations of epinephrine are suitable for use in of plastic surgery, considering that there was no significant difference in the duration of vasoconstriction. Furthermore, when using a solution of 1% lidocaine with epinephrine, it is recommended to neutralize the solution by mixing it with 8.4% sodium bicarbonate, at a 10:1 ratio to minimize pain.

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