What is the role of epinephrine in the performance of therapeutic injections for pain management?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Several agents are used to prolong or modify the action of LAs. As already discussed, epinephrine causes vasoconstriction, which reduces vascular and systemic absorption of the drug from the intended site of action, lowers the risk of systemic toxicity, and enhances LA efficacy on the target tissue. Epinephrine is the agent most often combined with LAs, which have a short to moderate duration of action. Epinephrine is contraindicated in some patients because of side effects or drug sensitivity or when a compromise of blood flow should be avoided (ie, when used in distal portions of the extremities, especially with coexisting peripheral vascular disease). Phenylephrine and norepinephrine (NE) also have been used as vasoconstrictors for spinal anesthesia; however, they do not appear to provide any significant advantage over the more commonly used epinephrine.

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