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Buffered local anesthetics and epinephrine degradation
C S Murakami1, P B Odland, B K Ross
1Department of Otolaryngology--Head and Neck Surgery, University of Washington Medical School, Seattle 98195.
The Journal of Dermatologic Surgery and Oncology
|March 1, 1994
Summary
Buffering lidocaine with epinephrine using sodium bicarbonate to reduce injection pain may degrade epinephrine. This study found significant epinephrine degradation in some buffered solutions, impacting anesthetic effectiveness and hemostasis.
Area of Science:
- Anesthesiology
- Pharmacology
- Biochemistry
Background:
- Lidocaine with epinephrine is a standard local anesthetic for facial surgery, providing anesthesia and hemostasis.
- Commercial formulations have a low pH (3.5-5.5) due to epinephrine instability, causing injection pain.
- Buffering with sodium bicarbonate is sometimes used to mitigate pain, but its effect on epinephrine stability is unclear.
Purpose of the Study:
- To investigate the stability of epinephrine in local anesthetic solutions when buffered with sodium bicarbonate.
- To determine the impact of pH alteration on epinephrine integrity for clinical use.
Main Methods:
- High-performance liquid chromatography (HPLC) was used to quantify epinephrine levels.
- Epinephrine solutions were prepared and buffered with sodium bicarbonate.
- Degradation of epinephrine was measured at altered pH levels.
Main Results:
- Significant degradation of epinephrine was observed in some buffered specimens.
- The addition of sodium bicarbonate led to a reduction in measurable epinephrine concentrations.
- The extent of degradation varied among the tested samples.
Conclusions:
- Buffering lidocaine with epinephrine using sodium bicarbonate can lead to substantial epinephrine degradation.
- This degradation may compromise the anesthetic and hemostatic efficacy of the agent.
- Caution is advised when using buffered local anesthetics; further research on optimal buffering strategies is recommended.