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Epinephrine Affects Pharmacokinetics of Ropivacaine Infiltrated Into Palate
Mikiko Yamashiro DDS, PhD,
 Shuichi Hashimoto PhD,
 Asako Yasuda DDS, PhD, and
 Katsuhisa Sunada DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 63: Issue 2
Online Publication Date: Jan 01, 2016
DOI: 10.2344/0003-3006-63.2.71
Page Range: 71 – 79

Ropivacaine, a levorotatory isomer (S-), has been widely used in clinical anesthesiology because of its decreased potential for systemic toxicity compared with the dextrorotatory isomer (R+) 1 as well as its high local anesthetic potency and long duration of action. The efficacy of dental conduction anesthesia with ropivacaine has been demonstrated. 2 – 4 Kimi et al 5 observed that ropivacaine has a strong affinity for the palatal mucosa and maxillary nerve but not for the maxilla in vitro, and the concentration remained high in the

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Hiromi Kimi DDS, PhD,
 Mikiko Yamashiro DDS, PhD, and
 Shuichi Hashimoto PhD
Article Category: Research Article
Volume/Issue: Volume 59: Issue 2
Online Publication Date: Jan 01, 2012
Page Range: 75 – 81

Since the clinical introduction of ropivacaine, its safety in the central nervous and cardiovascular systems compared with bupivacaine has attracted attention. 1 Ropivacaine is also widely used for infiltration anesthesia in Europe. 2 – 4 Ropivacaine used for inferior alveolar nerve block has been reported to induce effective anesthesia with a long duration. 5 , 6 On the other hand, there are individual differences in the effects of infiltration anesthesia with ropivacaine on the dental pulp, and its anesthetic efficacy has been reported

Eman El-Sharrawy MBBCh, MSc, MD and
 John A. Yagiela DDS, PhD
Article Category: Other
Volume/Issue: Volume 53: Issue 1
Online Publication Date: Jan 01, 2006
Page Range: 3 – 7

Ropivacaine is a long-acting aminoamide local anesthetic structurally related to bupivacaine and mepivacaine. 1 Its clinical profile is similar to that of bupivacaine but with fewer cardiac and central nervous system adverse effects. 2 Various controlled clinical studies have demonstrated that ropivacaine is a suitable choice for peripheral nerve block. 3 4 Axillary brachial plexus block with ropivacaine provides adequate anesthesia for hand surgery 3 ; interscalene brachial plexus block with ropivacaine produces rapid onset of anesthesia and prolonged

Figure 1.; Mean onset time of anesthesia after ropivacaine nerve block (18 patients per group; each bracket indicates the standard deviation). *P < .001 compared with 0.25% ropivacaine; †P < .001 compared with 0.375% ropivacaine; and ‡ P < .05 compared with 0.5% ropivacaine.
Eman El-Sharrawy and
 John A. Yagiela
Figure 1.
Figure 1.

Mean onset time of anesthesia after ropivacaine nerve block (18 patients per group; each bracket indicates the standard deviation). *P < .001 compared with 0.25% ropivacaine; †P < .001 compared with 0.375% ropivacaine; and ‡ P < .05 compared with 0.5% ropivacaine.


Eman El-Sharrawy and
 John A. Yagiela
Figure 3.
Figure 3.

Mean duration of lip tissue anesthesia after ropivacaine nerve block (18 patients per group; each bracket indicates the standard deviation). *P < .001 compared with 0.25% ropivacaine; †P < .001 compared with 0.375% ropivacaine; and ‡P < .01 compared with 0.5% ropivacaine.


Eman El-Sharrawy and
 John A. Yagiela
Figure 4.
Figure 4.

Mean duration of analgesia after ropivacaine nerve block (18 patients per group; each bracket indicates the standard deviation). *P < .001 compared with 0.25% ropivacaine; †P < .001 compared with 0.375% ropivacaine; and ‡P < .01 compared with 0.5% ropivacaine.


Mikiko Yamashiro,
 Shuichi Hashimoto,
 Asako Yasuda, and
 Katsuhisa Sunada
<bold>Figure 7</bold>
Figure 7

Effect of ropivacaine on the blood flow rate of rat upper lip. After 20 μL of 0.9% NaCl (○), 0.5% ropivacaine (•), 10 μg/mL epinephrine (△), or ropivacaine with epinephrine (▴) was injected to the rat upper left lip, the labial blood flow rate was measured by a laser Doppler flow meter (ALF21, ADVANCE) with a contact-type probe. Data are mean ± SD (n = 4). *P < .05 epinepherine versus ropivacaine with epinephrine.


Eman El-Sharrawy and
 John A. Yagiela
Figure 2.
Figure 2.

Mean quality of anesthesia during surgery (18 patients per group; each bracket indicates the standard deviation). Rating scores are defined in Table 1. *P < .001 compared with 0.25% ropivacaine; †P < .001 compared with 0.375% ropivacaine.


Hiromi Kimi,
 Mikiko Yamashiro, and
 Shuichi Hashimoto
Figure 4.
Figure 4.

Tissue affinity of ropivacaine and lidocaine in vitro. The affinity of ropivacaine and lidocaine for oral tissues was evaluated by equilibrium dialysis. (A) The amounts of ropivacaine and lidocaine in palatal mucosa, maxillary nerve, brain, and liver after equilibrium dialysis for 26 hours. The radioactivity was converted to the amount of local anesthetic per wet weight of each tissue (nmol/mg wet weight). The uptakes of ropivacaine by the palatal mucosa and maxillary nerve were twice and 12 times higher than those of lidocaine, respectively. (B) The amounts of ropivacaine and lidocaine in maxilla and serum after equilibrium dialysis. The level of local anesthetic per protein content of each tissue was calculated (nmol/mg protein). The amount of lidocaine in the maxilla was 3.7 times higher than that of ropivacaine.


Mikiko Yamashiro,
 Shuichi Hashimoto,
 Asako Yasuda, and
 Katsuhisa Sunada
<bold>Figure 3</bold>
Figure 3

Distribution and concentration of ropivacaine in rat maxilla. After 0.5% 3H-ropivacaine was infiltrated into the right palatal mucosa proximal to the first molar without (○) or with (•) 10 μg/mL epinephrine, the radioactivity in (A) right palatal mucosa, (B) left palatal mucosa, (C) right maxilla part, or (D) left maxilla part was measured with the liquid scintillation counter. The concentration (ng/mg wet weight) of ropivacaine was calculated by the specific radioactivity. Data are mean ± SD (n = 7). *P < .05 versus the ropivacaine group.