Epinephrine HCl

Epinephrine HCl is a hormone and a neurotransmitter.

Hemostatic and anesthetic efficacy of 4% articaine HCl with 1:200,000 epinephrine and 4% articaine HCl with 1:100,000 epinephrine when administered intraorally for periodontal surgery.[Pubmed:17274713]

J Periodontol. 2007 Feb;78(2):247-53.

BACKGROUND: The objective of this double-masked, randomized, multicenter crossover study was to compare the efficacy of 4% articaine HCl with 1:100,000 epinephrine (A100) to 4% articaine HCl with 1:200,000 epinephrine (A200) for providing effective local anesthesia and hemostasis for periodontal surgery. METHODS: Anesthetic efficacy was based on patient self-report and lack of need for reinjection during the surgical procedures. Hemostatic properties of the formulations were compared using ratings of the surgeons' ability to visualize the surgical field and expectation for bleeding. The volume of blood collected during each surgical session also was measured and compared. RESULTS: Forty-two adult subjects (26 males and 16 females, mean age 46.3 +/- 9.7 years) diagnosed with moderate to severe periodontal disease requiring local anesthesia for matched bilateral periodontal surgery were enrolled and completed the study. Subjects reported satisfactory surgical anesthesia following the A100 and A200 formulations; no supplemental local anesthesia was administered. Significant differences between the A100 and A200 treatments were found for the surgeons' ability to visualize the surgical field (rated as clear 83.3% of the time with A100 and 59.5% of the time with A200; P = 0.008), bleeding expectation (rated as equal to or better than expected 85.7% of the time with A100 and 71.4% of the time with A200; P = 0.034), and volume of blood loss (54.9 +/- 36.0 ml for A100 and 70.2 +/- 53.0 ml for A200; P = 0.018). Sixteen patients experienced 27 mild or moderate adverse events; the most common were postoperative pain (nine patients) and swelling (eight patients). Six adverse events may have been related to treatment. The frequency of adverse events did not vary between formulations. CONCLUSIONS: For patients undergoing periodontal surgery, 4% articaine anesthetic formulations containing epinephrine (1:100,000 or 1:200,000) provided excellent surgical pain control. For patients who can tolerate higher amounts of epinephrine, the 4% articaine 1:100,000 epinephrine formulation had the additional therapeutic advantage of providing better visualization of the surgical field and less bleeding.

Hemodynamic changes comparing lidocaine HCl with epinephrine and articaine HCl with epinephrine.[Pubmed:23147329]

J Craniofac Surg. 2012 Nov;23(6):1703-8.

BACKGROUND: The aim of the present study was to analyze hemodynamic changes after the administration of either 2% lidocaine with epinephrine 1:100,000 (L100) or 4% articaine with epinephrine 1:200,000 (A200) in the surgical removal of symmetrically positioned lower third molars. METHODS: A prospective, randomized, double-blind, clinical trial was carried out involving 43 patients. Each patient underwent 2 surgeries on different occasions-one under local anesthesia with L100 and the other with A200. The following parameters were assessed at 4 different times: systolic, diastolic, and mean blood pressure; heart rate; oxygen saturation; rate pressure product (RPP); and pressure rate quotient (PRQ). RESULTS: No hypertensive peak was observed in systolic, diastolic, and mean blood pressure at any evaluation time. Moreover, the type of anesthetic solution did not affect diastolic blood pressure, oxygen saturation or PRQ during the surgeries. Statistically significant differences between groups were detected with regard to heart rate and RPP (P < 0.05). CONCLUSIONS: The epinephrine concentration (1:100,000 or 1:200,000) and local anesthetic solutions used (2% lidocaine or 4% articaine) influenced hemodynamic parameters without perceptible clinical changes in healthy patients undergoing lower third molar removal.

Iontophoretic administration of 2% lidocaine HCl and 1:100,000 epinephrine in humans.[Pubmed:9084949]

Clin J Pain. 1997 Mar;13(1):22-6.

OBJECTIVE: The primary objective was to evaluate the clinical safety and effectiveness of the iontophoretic administration of lidocaine HCl 2% and epinephrine 1:100,000 to induce local dermal anesthesia before intravenous (i.v.) cannulation. DESIGN: Section I: Open, nonblinded. Section II: Randomized, double-blind, placebo-controlled. SETTING: Section I: Healthy adult volunteers. Section II: Patients presenting for scheduled outpatient eye surgery. PATIENTS: Section I: Seven healthy adult volunteers. Section II: Forty-four patients requiring i.v. cannulation before scheduled eye surgery. INTERVENTIONS: Section I: Volunteers received iontophoresis of lidocaine HCl 2% with epinephrine 1:100,000 for a total delivery current of 40 mA min. Section II: Patients received iontophoresis for a total delivery current of 40 mA min of lidocaine HCl 2% with epinephrine 1:100,000 (active) or saline (control) immediately before intravenous cannulation with a 20-gauge i.v. catheter. MAJOR OUTCOME MEASURES: Section I: Venous blood plasma lidocaine levels, adverse events associated with iontophoresis. Section II: Patient and investigator assessment of analgesia, patient acceptance of iontophoresis, adverse events associated with iontophoresis. RESULTS: Section I: No detectable levels of lidocaine were identified in any blood plasma sample. Adverse effects were minimal and transitory. Section II: Pain was decreased following lidocaine iontophoresis in comparison with controls, as determined by the patients and investigators. Iontophoresis was well accepted by the patients. Adverse effects were minimal and transitory. CONCLUSIONS: Iontophoresis of lidocaine 2% with 1:100,000 epinephrine for short delivery times does not lead to delivery of clinically important systemic levels of lidocaine in healthy adults. Iontophoresis of lidocaine 2% with 1:100,000 epinephrine provides adequate skin anesthesia for placement of peripheral small-gauge i.v. catheters.

[pH-adjusted lidocaine HCl with or without epinephrine for epidural anesthesia].[Pubmed:2607912]

Ma Zui Xue Za Zhi. 1989 Sep;27(3):255-60.

Preparations of local anesthetics are prepared as acidic solutions of the salts to promote solubility and stability. In solution, these salts exist as both nonionized and ionized forms. The ratio depends on the pH of the solution, and it is only the non-ionized form that permeates the nerve membrane and sheath. This study of epidural analgesia was undertaken to determine the effect of increasing the pH of the lidocaine HCl by the addition of sodium bicarbonate. Parameters studied included the time of onset of analgesia (time between the completion of injection and the loss of scratch sensation at the left L1 dermatome), the spread of sensory blockade, the degree of motor block, and the blood pressure and heart rate. Eighty seven adult patients undergoing epidural anesthesia were divided into four groups. Group 1 patients were given 2% lidocaine HCl solution plus 1.5 mL normal saline per 10 mL of lidocaine (pH 5.55). Group 2 patients were given 2% lidocaine HCl solution plus 1.5 mL 7% sodium bicarbonate per 10 mL of lidocaine (pH 7.04). Group 3 received 2% lidocaine HCl solution with 1:200000 epinephrine plus 1.5 mL normal saline per 10 mL of lidocaine (pH 5.68). Group 4 received 2% lidocaine HCl solution with 1:200000 epinephrine plus 1.5 mL 7% sodium bicarbonate per 10 mL of lidocaine (pH 7.11). The time of onset of analgesia and the spread of sensory blockade were more rapid in groups 2 and 4. The degree of motor block was more pronounced in these two groups, as were the changes in blood pressure and heart rate.

L-Epinephrine hydrochloride ((-)-Epinephrine hydrochloride; L-Adrenaline hydrochloride; (-)-Adrenalin hydrochloride), an endogenous neurotransmitter hormone, is used for the treatment of allergic and respiratory disorders.

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