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Canadian Journal of Anaesthesia

, Volume 36, Issue 4, pp 397–401 | Cite as

The effect of local anaesthetics on epine-phrine absorption following rectal mucosal infiltration

  • N. Flynn
  • D. P. O’Toole
  • E. Bourke
  • K. O’Malley
  • A. J. Cunningham
Reports of Investigation

Abstract

This study was undertaken to investigate the effects of lidocaine and bupivacaine on epinephrine absorption following rectal mucosal infiltration, to assess the cardiovascular and metabolic effects of the absorbed epinephrine and to compare the systemic absorption of the local anaesthetics employed. Three groups of five greyhounds received 1.5 μg · kg−1 of epinephrine 1:200,000 in lidocaine 0.5 per cent, bupivacaine 0.5 per cent or 0.9 per cent saline. Plasma epinephrine, lidocaine, bupivacaine, lactate, glucose and potassium concentrations were measured at 1, 2, 5, 10, 15 and 30 minutes following infiltration. Plasma epinephrine concentrations were significantly higher in the lidocaine group at one and two minutes following infiltration. Plasma bupivacaine concentrations were significantly higher than plasma lidocaine concentrations throughout the study period. There were no significant differences in metabolic or biochemical indices within or between the three groups. A local vasodilatory action of lidocaine may enhance epinephrine absorption. Differences in hepatic uptake and rate of metabolism may explain the increased plasma bupivacaine measured. Lidocaine may be the local anaesthetic of choice for ano-rectal procedures, especially when large volumes of local anaesthetic are being infiltrated.

Key words

anaesthetics, local: bupivacaine, lidocaine, absorption sympathetic nervous system: pharmacology, epinephrine 

Résumé

Ce travail avait pour but de comparer la lidocaine et la bupivacaïne injectées dans la muqueuse rectale quant à leur absorption et à leur effet sur l’absorption de l’adrénaline. On voulait aussi mesurer l’impact cardiovasculaire et métabolique de l’adrénaline. Nous avons injecté 1.5 μg · kg−1 d’adrénaline 1:200,000 avec soit de la lidocaine 0.5 pour cent, soit de la bupivacaïne 0.5 pour cent ou du NaCl 0.9 pour cent chez trois groupes de cinq lévriers. Les mesures sériées des concentrations sériques d’adrénaline, de lidocaïne, de bupivacaïne, de lactate, de glucose et de potassium étaient faites 1, 2, 5, 10, 15 et 30 minutes après l’infltraiton de la muqueuse. Nous avons mesuré des concentrations sériques d’ adrénaline plus élevées dans le groupe lidocaïne à une et deux minutes et trouvé que les niveaux plasmatiques de bupivacaine étaient systématiquement supérieurs à ceux de lidocaïne. Les variables métaboliques et biochimiques étaient semblables d’un groupe à l’autre. En vasodilatant, la lidocaïne peut faciliter l’absorption de l’adrénaline alors qu’une captation hépatique et un métabolisme plus faibles pourraient expliquer les niveaux plasmatiques élevés de bupivacaïne. La lidocaïne est probablement le meilleur choix pour les infiltrations locales de grands volumes d’anesthésique lors de chirurgies ano-rectales.

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Copyright information

© Canadian Anesthesiologists 1989

Authors and Affiliations

  • N. Flynn
    • 1
  • D. P. O’Toole
    • 1
  • E. Bourke
    • 1
  • K. O’Malley
    • 1
  • A. J. Cunningham
    • 1
  1. 1.Department of Anaesthesia and Clinical PharmacologyRoyal College of Surgeons in IrelandDublinIreland

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