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.