Properties of Adrenaline or Epinephrine
- Prolongs duration of action for lidocaine and enhances margin of safety
- Beta-adrenergic activity which may cause blood pressure to rise
- Alpha actions, such as vasoconstriction of blood vessels in skin and mucosa
- Cardiac effects may be minimal but can be significant
- Increases cardiac output in healthy as well as cardiac patients
- Debate as to whether to avoid epinephrine in cardiac patients or those taking beta-blockers
- May induce a decrease in plasma levels of potassium or increases in glucose levels but not clinically significant
- Contraindicated in patients intoxicated with cocaine
- Local anesthetics with epinephrine may cause delayed wound healing and increased incidence of dry sockets
- Epinephrine is metabolized in the liver and metabolites are largely excreted in the urine
Felypressin
- A synthetic analogue of vasopressin
- Does not have oxytocin-like actions or anti-diuretic actions of vasopressin
- Minimal toxic effects even if delivered intravenously
- No evidence that prilocaine with felypressin is safer than lidocaine with epinephrine
Source: Anesthesia Complications in the Dental Office, Wiley Blackwell 2015.