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Hemodynamic and Blockade Effects of High/low Epinephrine Doses During Axillary Brachial Plexus Blockade With Lidocaine 1.5%: A Randomized, Double-blinded Study
  1. Kudret Dogru, M.D.,
  2. Fuat Duygulu, M.D.,
  3. Karamehmet Yildiz, M.D.,
  4. Mustafa Sirri Kotanoglu, M.D.,
  5. Halit Madenoglu, M.D. and
  6. Adem Boyaci, M.D.
  1. From the Department of Anesthesiology and the Department of Orthopedics and Traumatology, Erciyes University Medical Faculty, Kayseri, Turkey
  1. Reprint requests: Dr. Kudret Dogru, Department of Anesthesiology and Reanimation, Erciyes University Medical Faculty, 38039, Kayseri, Turkey. E-mail: kdogru{at}


Background and Objectives: Although epinephrine commonly is added to local anesthetics for regional anesthesia, rarely it may cause undesirable hemodynamic side effects. This study compared the hemodynamic and blockade effects of 25 and 200 μg epinephrine during axillary brachial plexus blockade with lidocaine 1.5%.

Methods: Sixty American Society of Anesthesiologist classification I or II patients were divided randomly into 3 groups. Patients in group 1 received 5 mL of saline containing 25 μg epinephrine and then 35 mL of 1.5% lidocaine; patients in group 2 received 5 mL of saline alone and then 200 μg of epinephrine mixed with 35 mL of 1.5% lidocaine; patients in group 3 received 5 mL of saline alone and then 35 mL of 1.5% lidocaine. Hemodynamic data were measured for 1 to 10 minutes at 1-minute intervals after axillary injection. The duration time of motor and sensory block was recorded.

Results: Complete anesthesia was achieved in 85% of patients in groups 1 and 3 and 90% in group 2. Motor block duration was significantly longer in group 2 than in groups 1 and 3 (P < .05). There were no significant differences in analgesia between groups 1 and 2. Analgesia duration was significantly longer in groups 1 and 2 than in group 3 (P < .05). Heart rate from the 3rd to 6th minute was higher in group 2 than in groups 1 and 3 (P < .05). Systolic arterial pressure from the 3rd to 5th minute and diastolic arterial pressure from 2nd to 6th minute were higher in group 2 than in groups 1 and 3 (P < .05).

Conclusions: Low-dose epinephrine offers more stable hemodynamics and similar blockade, and thus may be beneficial for patients undergoing forearm and hand surgery who are at risk for tachycardia and/or hypertension.

  • Lidocaine
  • Axillary brachial plexus blockade
  • Epinephrine
  • Heart rate
  • Systolic and diastolic blood pressure

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