Anesthesia combination with adrenaline

Clinical use Etidocaine in combination with adrenaline is employed for infiltration anesthesia using solutions of 0.5% and peripheral nerve block at 0.5 and 1.0 % with a duration of 3 to 12 h (Tetzlaff, 2000). Epidural anesthesia is achieved with 1.0 to 1.5 % solutions with a duration of 3 to 5 h. Due to a profound motor block sometimes associated with unsatisfactory sensory block etidocaine is disadvantegous compared to bupivacaine. 

Clinical use Because of its poor penetration of intact mucous membranes, procaine is largely ineffective for topical applications and has been mainly used in injection in combination with adrenaline, although in general it has been replaced by other LAs such as lidocaine. For infiltration anesthesia, 0.25 to 0.5 % solutions of procaine have been used in doses up to 600 mg. For peripheral nerve block, a common dose of 500 mg of procaine has been given as a 0.5 to 2.0 % solution. 

Clinical use Tetracaine is employed by ophthalmologists for surface anesthesia as a 0.5 % solution and by endoscopists for anesthesia of mucous membranes including airways as a 2.0 % solution. For topical anesthesia, a 4.0 % cream of tetracaine can also be used, which is, however, less effective than a lidocaine/prilocaine cream in preventing venipuncture-induced pain in children (van Kan et al., 1997). A combination of tetracaine with adrenaline and cocaine (TAC) is widely used for repair of... 

Ropivacaine is an amide-type LA, a vasoconstrictor at less than 1% and a vasodilator at more than 1%. The fact that it is the pure S-enantiomer reduces its toxicity. Like phenol, it is metabolized by the liver and eliminated by the kidneys. When administered by dermal injection, it has a rapid onset of action (less than a minute) and the duration of action is longer than or equal to that of bupivacaine. Combining it with adrenaline does not prolong its duration of action, and a concentration of 0.75% provides longer anesthesia than a concentration of 1%. Neurological and cardiovascular tolerance to ropivacaine is much better than to bupivacaine. What is more, there is a considerable difference between the neurotoxic and cardiotoxic doses. The toxicity of ropivacaine is intermediate between that of lidocaine and bupivacaine. Direct intravascular injection of ropivacaine is still dangerous, however. 

Hyaluronidase has found applications as an additive to the anesthetic agents used for peribulbar anesthesia for vitreoretinal surgery. Combinations of hyaluronidase with bupivacaine [119], lidocaine and epinephrine [120], lignocaine and adrenaline [121], or lidocaine and bupivacaine [122] were judged very... 

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