{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T12:40:12Z","timestamp":1756384812492},"reference-count":25,"publisher":"American Dental Society of Anesthesiology (ADSA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016]]},"abstract":"<jats:p>Pulpal anesthesia success rates for ropivacaine following maxillary infiltration anesthesia seem to be low. We investigated the hypothesis that the addition of epinephrine would affect the pharmacokinetics of ropivacaine by retaining ropivacaine in the mucosa of the injected area through the time-dependent distribution of ropivacaine in the rat maxilla and serum following maxillary infiltration anesthesia using <jats:sup>3<\/jats:sup>H-labeled ropivacaine. We then examined the vasoactivity of ropivacaine with or without epinephrine on local peripheral blood flow. The addition of epinephrine to ropivacaine increased ropivacaine concentrations in the palatal mucosa and adjacent maxilla by more than 3 times that of plain ropivacaine at 20 minutes. By observing the autoradiogram of <jats:sup>3<\/jats:sup>H-ropivacaine, plain ropivacaine in the maxilla was remarkably reduced 20 minutes after injection. However, it was definitely retained in the palatal mucosa, hard palate, adjacent maxilla, and maxillary nerve after the administration with epinephrine. Ropivacaine with epinephrine significantly decreased labial blood flow. This study suggests that 10 \u03bcg\/mL epinephrine added to 0.5% ropivacaine could improve anesthetic efficacy and duration for maxillary infiltration anesthesia over plain ropivacaine.<\/jats:p>","DOI":"10.2344\/0003-3006-63.2.71","type":"journal-article","created":{"date-parts":[[2016,6,6]],"date-time":"2016-06-06T22:05:52Z","timestamp":1465250752000},"page":"71-79","source":"Crossref","is-referenced-by-count":7,"title":["Epinephrine Affects Pharmacokinetics of Ropivacaine Infiltrated Into Palate"],"prefix":"10.2344","volume":"63","author":[{"given":"Mikiko","family":"Yamashiro","sequence":"first","affiliation":[{"name":"The Nippon Dental University, School of Life Dentistry at Tokyo, Department of Dental Anesthesiology, Tokyo, Japan, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuichi","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"The Nippon Dental University, School of Life Dentistry at Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asako","family":"Yasuda","sequence":"additional","affiliation":[{"name":"The Nippon Dental University, School of Life Dentistry at Tokyo, Department of Dental Anesthesiology, Tokyo, Japan, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katsuhisa","family":"Sunada","sequence":"additional","affiliation":[{"name":"The Nippon Dental University, School of Life Dentistry at Tokyo, Department of Dental Anesthesiology, Tokyo, Japan, and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1191","reference":[{"key":"i0003-3006-63-2-71-b01","series-title":"Can J Anesth","first-page":"368","article-title":"Local anesthetic systemic toxicity","volume":"57","author":"Dillane \n              D,","year":"2010","unstructured":"Dillane \n              D, \n            \n            \n              Finucane \n              BT. \n            \n          \n          Local anesthetic systemic toxicity. Can J Anesth. 2010;57:368\u2013380."},{"key":"i0003-3006-63-2-71-b02","series-title":"J Oral Maxillofac Surg","first-page":"1004","article-title":"Ropivacaine for dental anesthesia: a dose-finding study","volume":"60","author":"Ernberg \n              M,","year":"2002","unstructured":"Ernberg \n              M, \n            \n            \n              Kopp \n              S. \n            \n          \n          Ropivacaine for dental anesthesia: a dose-finding study. J Oral Maxillofac Surg. 2002;60:1004\u20131010."},{"key":"i0003-3006-63-2-71-b03","series-title":"N Y State Dent J","first-page":"36","article-title":"The assessment of anesthetic efficacy of ropivacaine in oral surgery","volume":"72","author":"Buric \n              N.","year":"2006","unstructured":"Buric \n              N. \n            \n          \n          The assessment of anesthetic efficacy of ropivacaine in oral surgery. N Y State Dent J. 2006;72:36\u201339."},{"key":"i0003-3006-63-2-71-b04","series-title":"Anesth Prog","first-page":"3","article-title":"Anesthetic efficacy of different ropivacaine concentrations for inferior alveolar nerve block","volume":"53","author":"El-Sharrawy \n              E,","year":"2006","unstructured":"El-Sharrawy \n              E, \n            \n            \n              Yagiela \n              JA. \n            \n          \n          Anesthetic efficacy of different ropivacaine concentrations for inferior alveolar nerve block. Anesth Prog. 2006;53:3\u20137."},{"key":"i0003-3006-63-2-71-b05","series-title":"Anesth Prog","first-page":"75","article-title":"The local pharmacokinetics of 3H-ropivacaine and 14C-lidocaine after maxillary infiltration anesthesia in rats","volume":"59","author":"Kimi \n              H,","year":"2012","unstructured":"Kimi \n              H, \n            \n            \n              Yamashiro \n              M, \n            \n            \n              Hashimoto \n              S. \n            \n          \n          The local pharmacokinetics of 3H-ropivacaine and 14C-lidocaine after maxillary infiltration anesthesia in rats. Anesth Prog. 2012;59:75\u201381."},{"key":"i0003-3006-63-2-71-b06","series-title":"Ann Plast Surg","first-page":"409","article-title":"Comparative efficacy of ropivacaine and bupivacaine infiltrative analgesia in otoplasty","volume":"54","author":"Kanagia \n              D,","year":"2005","unstructured":"Kanagia \n              D, \n            \n            \n              Fotiadis \n              S, \n            \n            \n              Tripsiannis \n              G. \n            \n          \n          Comparative efficacy of ropivacaine and bupivacaine infiltrative analgesia in otoplasty. Ann Plast Surg. 2005;54:409\u2013411."},{"key":"i0003-3006-63-2-71-b07","series-title":"Anesth Analg","first-page":"987","article-title":"A double-blinded, randomized comparison of either 0.5% levobupivacaine or 0.5% ropivacaine for sciatic nerve block","volume":"94","author":"Casati \n              A,","year":"2002","unstructured":"Casati \n              A, \n            \n            \n              Borghi \n              B, \n            \n            \n              Fanelli \n              G, \n            \n            et al. \n          A double-blinded, randomized comparison of either 0.5% levobupivacaine or 0.5% ropivacaine for sciatic nerve block. Anesth Analg. 2002;94:987\u2013990."},{"key":"i0003-3006-63-2-71-b08","series-title":"Eur J Surg","first-page":"371","article-title":"Preoperative local infiltration with ropivacaine for postoperative pain relief after inguinal hernia repair: a randomised controlled trial","volume":"163","author":"Johansson \n              B,","year":"1997","unstructured":"Johansson \n              B, \n            \n            \n              Hallerback \n              B, \n            \n            \n              Stubberod \n              A, \n            \n            et al. \n          Preoperative local infiltration with ropivacaine for postoperative pain relief after inguinal hernia repair: a randomised controlled trial. Eur J Surg. 1997;163:371\u2013378."},{"key":"i0003-3006-63-2-71-b09","series-title":"Reg Anesth Pain Med","first-page":"136","article-title":"Ropivacaine 0.25% and 0.5%, but not 0.125%, provide effective wound infiltration analgesia after outpatient hernia repair, but with sustained plasma drug levels","volume":"24","author":"Mulroy \n              MF,","year":"1999","unstructured":"Mulroy \n              MF, \n            \n            \n              Burgess \n              FW, \n            \n            \n              Emanuelsson \n              BM. \n            \n          \n          Ropivacaine 0.25% and 0.5%, but not 0.125%, provide effective wound infiltration analgesia after outpatient hernia repair, but with sustained plasma drug levels. Reg Anesth Pain Med. 1999;24:136\u2013141."},{"key":"i0003-3006-63-2-71-b10","series-title":"Can J Anaesth","first-page":"878","article-title":"Plasma concentrations of ropivacaine given with or without epinephrine for brachial plexus block","volume":"37","author":"Hickey \n              R,","year":"1990","unstructured":"Hickey \n              R, \n            \n            \n              Blanchard \n              J, \n            \n            \n              Hoffman \n              J, \n            \n            \n              Sjovall \n              J, \n            \n            \n              Ramamurthy \n              S. \n            \n          \n          Plasma concentrations of ropivacaine given with or without epinephrine for brachial plexus block. Can J Anaesth. 1990;37:878\u2013882."},{"key":"i0003-3006-63-2-71-b11","series-title":"Br J Anaesth","first-page":"881","article-title":"Effect of epinephrine on epidural, intrathecal, and plasma pharmacokinetics of ropivacaine and bupivacaine in sheep","volume":"99","author":"Ratajczak-Enselme \n              M,","year":"2007","unstructured":"Ratajczak-Enselme \n              M, \n            \n            \n              Estebe \n              J-P, \n            \n            \n              Rose \n              F-X, \n            \n            et al. \n          Effect of epinephrine on epidural, intrathecal, and plasma pharmacokinetics of ropivacaine and bupivacaine in sheep. Br J Anaesth. 2007;99:881\u2013890."},{"key":"i0003-3006-63-2-71-b12","series-title":"Oral Surg Oral Med Oral Pathol","first-page":"406","article-title":"Anesthetic efficacy of ropivacaine in maxillary anterior infiltration","volume":"91","author":"Kennedy \n              M,","year":"2001","unstructured":"Kennedy \n              M, \n            \n            \n              Reader \n              A, \n            \n            \n              Beck \n              M, \n            \n            \n              Weaver \n              J. \n            \n          \n          Anesthetic efficacy of ropivacaine in maxillary anterior infiltration. Oral Surg Oral Med Oral Pathol. 2001;91:406\u2013412."},{"key":"i0003-3006-63-2-71-b13","series-title":"Reg Anesth Pain Med","first-page":"233","article-title":"Altered blood flow in terminal vessels after local application of ropivacaine and prilocaine","volume":"32","author":"Wienzek \n              H,","year":"2007","unstructured":"Wienzek \n              H, \n            \n            \n              Freise \n              H, \n            \n            \n              Giesler \n              I, \n            \n            \n              Van Aken \n              H, \n            \n            \n              Sielenkaemper \n              AW. \n            \n          \n          Altered blood flow in terminal vessels after local application of ropivacaine and prilocaine. 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Acta Anaesthesiol Scand. 1991;35:208\u2013215."},{"key":"i0003-3006-63-2-71-b15","series-title":"Drug Metab Dispos","first-page":"962","article-title":"Metabolism and excretion of ropivacaine in humans","volume":"24","author":"Halldin \n              MM,","year":"1996","unstructured":"Halldin \n              MM, \n            \n            \n              Bredberg \n              E, \n            \n            \n              Angelin \n              B, \n            \n            et al. \n          Metabolism and excretion of ropivacaine in humans. Drug Metab Dispos. 1996;24:962\u2013968."},{"key":"i0003-3006-63-2-71-b16","series-title":"Anesth Analg","first-page":"736","article-title":"Disposition kinetics of ropivacaine in humans","volume":"69","author":"Lee \n              A,","year":"1989","unstructured":"Lee \n              A, \n            \n            \n              Fagan \n              D, \n            \n            \n              Lamont \n              M, \n            \n            \n              Tucker \n              GT, \n            \n            \n              Halldin \n              M, \n            \n            \n              Scott \n              DB. \n            \n          \n          Disposition kinetics of ropivacaine in humans. 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St Louis, Mo: Elsevier;2013:18\u201320."},{"key":"i0003-3006-63-2-71-b19","series-title":"Reg Anesth Pain Med","first-page":"307","article-title":"The effect of adjuvant epinephrine concentration on the vasoactivity of the local anesthetics bupivacaine and levobupivacaine in human skin","volume":"29","author":"Newton \n              DJ,","year":"2004","unstructured":"Newton \n              DJ, \n            \n            \n              McLeod \n              GA, \n            \n            \n              Khan \n              F, \n            \n            \n              Belch \n              JJF. \n            \n          \n          The effect of adjuvant epinephrine concentration on the vasoactivity of the local anesthetics bupivacaine and levobupivacaine in human skin. Reg Anesth Pain Med. 2004;29:307\u2013311."},{"key":"i0003-3006-63-2-71-b20","series-title":"J Jpn Dent Soc Anesthesiol","first-page":"1","article-title":"Effects of adrenaline on the pharmacokinetics of 14C-lidocaine after maxillary infiltration anesthesia in rats [in Japanese]","volume":"39","author":"Yasuda \n              A,","year":"2011","unstructured":"Yasuda \n              A, \n            \n            \n              Yamashiro \n              M, \n            \n            \n              Hashimoto \n              S, \n            \n            \n              Sunada \n              K. \n            \n          \n          Effects of adrenaline on the pharmacokinetics of 14C-lidocaine after maxillary infiltration anesthesia in rats [in Japanese]. J Jpn Dent Soc Anesthesiol. 2011;39:1\u201312."},{"key":"i0003-3006-63-2-71-b21","series-title":"Reg Anesth","first-page":"18","article-title":"Sensory, motor, and sympathetic block during epidural analgesia with 0.5% and 0.75% ropivacaine with and without epinephrine","volume":"19","author":"Cederholm \n              I,","year":"1994","unstructured":"Cederholm \n              I, \n            \n            \n              Anskar \n              S, \n            \n            \n              Bengtsson \n              M. \n            \n          \n          Sensory, motor, and sympathetic block during epidural analgesia with 0.5% and 0.75% ropivacaine with and without epinephrine. 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Br J Anaesth. 2005;95:696\u2013700."},{"key":"i0003-3006-63-2-71-b24","series-title":"Pharmacology & Physiology in Anesthetic Practice. 4th ed","first-page":"180","author":"Stoelting \n              RK,","year":"2006","unstructured":"Stoelting \n              RK, \n            \n            \n              Hillier \n              SC. \n            \n          \n          Pharmacology & Physiology in Anesthetic Practice. 4th ed. Philadelphia: Lippincott Williams & Wilkins;2006:180\u2013181."},{"key":"i0003-3006-63-2-71-b25","series-title":"Acta Pharmacol Toxicol","first-page":"273","article-title":"Toxicological and local anaesthetic effects of optically active isomers of two local anaesthetic compounds","volume":"31","author":"Aaberg \n              G.","year":"1972","unstructured":"Aaberg \n              G. \n            \n          \n          Toxicological and local anaesthetic effects of optically active isomers of two local anaesthetic compounds. 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