Use of Midodrine for Intraoperative Hemostasis in Cutaneous and Percutaneous Surgery

Due to the increasingly high volume of cutaneous and percutaneous procedures performed annually, the demand for local anesthesia has steadily risen. The gold standard formulations for local anesthesia contain epinephrine at a concentration of 1:100,000 to aid in hemostasis. Epinephrine contains off-target effects that carry risk of adverse events from injections with these injections. Further, the ongoing global shortage of epinephrine highlights the need for a safer and viable alternative. Midodrine, an a1-adrenergic receptor agonist, is utilized as a vasopressor to induce arterial and venous vasoconstriction. We developed a novel formulation of 2% lidocaine combined with 1:2,000,000 epinephrine and 50uM midodrine. In a porcine model of blood loss following punch biopsies, our formulation was compared to 2% lidocaine, 2% lidocaine with 1:100,000 epinephrine, 2% lidocaine with 1:2,000,000 epinephrine, and 2% lidocaine with 50uM midodrine. Our results indicate that 2% lidocaine with 1:100,000 epinephrine and our novel formulation were statistically comparable and both significantly reduced bleeding when compared to the 2% lidocaine (p< 0.05). 2% lidocaine with midodrine alone also showed additional promise as an effective hemostatic formulation.

鉴于每年皮肤及皮下手术量的不断攀升，局部麻醉的需求亦持续增长。局部麻醉的金标准配方中包含浓度为1:100,000的肾上腺素，以协助止血。然而，肾上腺素具有非靶点效应，这些注射可能导致不良反应的风险。此外，全球范围内肾上腺素的持续短缺凸显了开发更安全、可行的替代品的需求。米多君，作为一种α1-肾上腺素受体激动剂，被用作血管加压剂以引起动脉和静脉的血管收缩。本研究开发了一种新型的2%利多卡因配方，其中含有浓度为1:2,000,000的肾上腺素和50微摩尔米多君。在猪模型中，该配方在打孔活检后的出血模型中被与2%利多卡因、2%利多卡因加1:100,000肾上腺素、2%利多卡因加1:2,000,000肾上腺素以及2%利多卡因加50微摩尔米多君进行比较。我们的研究结果指出，2%利多卡因加1:100,000肾上腺素和我们的新型配方在统计学上相当，且与2%利多卡因相比，两者均显著降低了出血量（p<0.05）。单独使用含米多君的2%利多卡因配方也显示出作为有效止血配方的额外潜力。