Prospective Evaluation of the Optimal Concentration and Effect of Epinephrine as an Adjuvant to Local Anesthetics for Prolonging Block Duration and Reducing Systemic Toxicity in Outpatient Surgery

Year : 2026 | Volume : 16 | Issue : 01 | Page : 64 69
    By

    Pratul,

  • Deepanshu Sharma,

  • Masrata Gull,

  1. Student, Department of Anesthesia, Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India
  2. Assistant Professor, Department of Anesthesia, Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Mullana, Ambala, Haryana, India
  3. Student, Department of Anesthesia, Student of Dolphin PG College, Chunni, Kalan, Punjab, India

Abstract

Purpose: To evaluate the optimal concentration and effect of epinephrine as an adjuvant to local anesthetics for prolonging block duration and reducing systemic toxicity in outpatient surgery. Methods: The study involved a randomized double-blind clinical trial on 80 adult patients awaiting day-care extremity surgery. The patients were randomly assigned to two groups of equal size. One group, Group E, was given the local anesthetic agent along with epinephrine as an adjuvant, while the other group, Group C, was given the local anesthetic agent without the adjuvant. The outcome measures evaluated in the study included the duration of the anesthetic block and the occurrence of systemic toxicity or other adverse effects associated with the anesthetic agents. The secondary outcome measures included the measurement of the hemodynamic parameters such as the patient’s heart rate and blood pressure, the evaluation of the intraoperative and postoperative stability of the patients, and the evaluation of the patient’s recovery profiles. Results: Epinephrine significantly increased block duration (mean 180 min vs 130 min, p < 0.001), reduced nausea/vomiting and increased bradycardia/hypotension rates. No serious adverse events occurred. Conclusions: Epinephrine is effective for prolonging anesthesia block with a manageable safety profile when correctly dosed

Keywords: Adjuvants, epinephrine, local anesthetics, nerve block, outpatient surgery, randomized controlled trial, regional anesthesia, systemic toxicity

[This article belongs to Research and Reviews: A Journal of Toxicology ]

How to cite this article:
Pratul, Deepanshu Sharma, Masrata Gull. Prospective Evaluation of the Optimal Concentration and Effect of Epinephrine as an Adjuvant to Local Anesthetics for Prolonging Block Duration and Reducing Systemic Toxicity in Outpatient Surgery. Research and Reviews: A Journal of Toxicology. 2026; 16(01):64-69.
How to cite this URL:
Pratul, Deepanshu Sharma, Masrata Gull. Prospective Evaluation of the Optimal Concentration and Effect of Epinephrine as an Adjuvant to Local Anesthetics for Prolonging Block Duration and Reducing Systemic Toxicity in Outpatient Surgery. Research and Reviews: A Journal of Toxicology. 2026; 16(01):64-69. Available from: https://journals.stmjournals.com/rrjot/article=2026/view=240791


References

  1. Swain A, Nag DS, Sahu S, Samaddar DP. Adjuvants to local anesthetics: Current understanding and future trends. World J Clin Cases. 2017;5(8):307–323. doi: 12998/wjcc.v5.i8.307.
  2. Sharma A, Kaur K, Singh PM. Equal mixture of 2% lidocaine with adrenaline and 0.5% bupivacaine for minor outpatient surgery. Reg Anesth Pain Med. 2024;49(2):112–118.
  3. Brummett CM, Norat MA, Palmisano JM, Lydic R. Perineural dexmedetomidine added to ropivacaine causes a dose-dependent increase in the duration of thermal antinociception in sciatic nerve block in rat. Anesthesiology. 2008;109(3):502–511. doi:10.1097/ALN.0b013e318182c2f3.
  4. Becker DE, Reed KL. Local anesthetics: Review of pharmacological considerations. Anesth Prog. 2012;59(2):90–101.
  5. Neal JM, Woodward CM, Harrison TK. The American Society of Regional Anesthesia and Pain Medicine checklist for treatment of local anesthetic systemic toxicity. Reg Anesth Pain Med. 2025;50(1):12–20.
  6. Kahn CH, Peden CJ. Use of local anesthetics with an epinephrine additive on skin and soft tissue outcomes. J Dermatol Surg. 2024;50(4):425–432.
  7. Butterworth JF, Mackey DC, Wasnick JD. Infiltrative administration of local anesthetic agents. In: Morgan & Mikhail’s Clinical Anesthesiology. 6th ed. New York: McGraw-Hill; 2022.
  8. Denkler KA. A comprehensive review of epinephrine in the finger: To do or not to do. Plast Reconstr Surg. 2001;108(1):114–124.
  9. Kirksey MA, Haskins SC, Cheng J, Liu SS. Local anesthetic peripheral nerve block adjuvants for prolonging analgesia: Systematic qualitative review. PLoS One. 2015;10(9):e0137312.
  10. Becker DE, Reed KL. Principles of office anesthesia: Part I. Infiltrative anesthesia. Am Fam Physician. 2002;66(1):91–94.
  11. Liu SS, McDonald SB. Current issues in spinal anesthesia. Anesthesiology. 2004;101(1):223–237.
  12. Filos KS, Goudas LC, Patroni O, Polyzou V. Hemodynamic and analgesic profile after intrathecal clonidine in humans: A dose-response study. Anesthesiology. 1994;81(3):591–601.
  13. Brummett CM, Williams BA. Additives to local anesthetics for peripheral nerve blockade. Anesthesiology. 2011;115(2):466–468.
  14. Neal JM, Barrington MJ, Fettiplace MR, Gitman M, Memtsoudis SG. The third American Society of Regional Anesthesia practice advisory on local anesthetic systemic toxicity. Reg Anesth Pain Med. 2018;43(2):113–123.
  15. Neal JM, Mulroy MF, Weinberg GL. Local anesthetic systemic toxicity revisited: A paradigm in evolution. Anesth Analg. 2018;127(1):21–24.
  16. Rosenberg PH, Veering BT, Urmey WF. Maximum recommended doses of local anesthetics: A multifactorial concept. Reg Anesth Pain Med. 2004;29(6):564–575.
  17. Nashville Anesthesia Professionals. Maximum dose of local anesthesia. Nashville (TN): Nashville Anesthesia Pros; 2025.
  18. Chin KJ, Mariano ER, El-Boghdadly K. Local anesthetic dosing for fascial plane blocks to avoid systemic toxicity: A narrative review. Can J Anaesth. 2025;72(1):1–12.
  19. El-Boghdadly K, Pawa A, Chin KJ. Local anesthetic systemic toxicity. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
  20. Gitman M, Barrington MJ. Local anesthetic systemic toxicity: Current perspectives. Local Reg Anesth. 2018;11:35–44.
Regular Issue Subscription Original Research
Volume 16
Issue 01
Received 10/01/2026
Accepted 01/02/2026
Published 15/04/2026
Publication Time 95 Days
10

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