Impact of Epinephrine Contained in Local Anesthetic Solution on Serum Lactate Level During Orthognathic Surgery

There have been many discussions of a relation between endogenous and exogenous epinephrine and hyperlactatemia. This study aimed to identify the impact of epinephrine contained in a local anesthetic solution on serum lactate levels in patients who underwent orthognathic surgery.

This study was a retrospective record review of cases of maxillary and mandibular osteotomy at the Tokyo University Hospital (Tokyo, Japan) from January 2006 through December 2014. One hundred ninety-three patients were enrolled in this study.

The maximum intraoperative serum lactate level was 22.3 ± 14.7 mg/dL. Of 193 patients, 91 showed an intraoperative serum lactate level that was higher than the normal maximum of 19.8 mg/dL (2.2 mmol/L), and 16 of these had a level that was at least 40 mg/dL (≥4.49 mmol/L). Multiple logistic regression analysis showed 2 factors that could increase the serum lactate level: the amount of epinephrine contained in the local anesthetic solution injected into the oral cavity (odds ratio [OR] = 1.014; 95% confidence interval [CI], 1.006-1.022; P = .0001) and the absence of intraoperative treatment with propranolol (OR, 0.105; 95% CI, 0.019-0.434; P = .0013). Patients with severe serum lactate concentrations (ie, ≥40 mg/dL [≥4.49 mmol/L]) had slight metabolic acidosis. All patients survived 90 days. The number of postoperative hospitalization days for patients with severe serum lactate concentrations was 12.8 ± 2.6 days and that for patients without severe serum lactate concentration was 16.0 ± 8.6 days.

Increases in intraoperative serum lactate levels during orthognathic surgery are associated, at least in part, with increased aerobic glycolysis because of β₂-adrenergic signaling. Lactate increase caused by epinephrine contained in a local anesthetic solution does not result in a poor postoperative outcome.