Hyperspectral Imaging to Study Dynamic Skin Perfusion after Injection of Articaine-4% with and without Epinephrine-Clinical Implications on Local Vasoconstriction

Daniel G E Thiem; Lukas Hans; Sebastian Blatt; Paul Römer; Diana Heimes; Bilal Al-Nawas; Peer W Kämmerer

doi:10.3390/jcm10153411

Hyperspectral Imaging to Study Dynamic Skin Perfusion after Injection of Articaine-4% with and without Epinephrine-Clinical Implications on Local Vasoconstriction

J Clin Med. 2021 Jul 31;10(15):3411. doi: 10.3390/jcm10153411.

Authors

Daniel G E Thiem¹, Lukas Hans¹, Sebastian Blatt¹, Paul Römer¹, Diana Heimes¹, Bilal Al-Nawas^{1

2}, Peer W Kämmerer¹

Affiliations

¹ Department of Oral and Maxillofacial Surgery, University Medical Centre Mainz, 55131 Mainz, Germany.
² Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul 05278, Korea.

Abstract

This study aimed to investigate the dynamic skin perfusion via hyperspectral imaging (HSI) after application of Articaine-4% ± epinephrine as well as epinephrine only. After the subcutaneous injection of (A100) Articaine-4% with epinephrine 1:100,000, (A200) Articaine-4% with epinephrine 1:200,000, (Aw/o) Articaine-4% without epinephrine, and (EPI200) epinephrine 1:200,000, into the flexor side of the forearm in a split-arm design, dynamic skin perfusion measurement was performed over 120 min by determining tissue oxygen saturation (StO₂) using HSI. After injection, all groups experienced a reactive hyperaemia. With A200, it took about three min for StO₂ to drop below baseline. For Aw/o and EPI200, perfusion reduction when compared to baseline was seen at 30 min with vasoconstriction >120 min. A100 caused vasodilation with hyperaemia >60 min. After three minutes, the perfusion pattern differed significantly (p < 0.001) between all groups except Aw/o and EPI200. The vasoactive effect of epinephrine-containing local anaesthetics can be visualised and dynamically quantified via StO2 using HSI. Aw/o + epinephrine 1:100,000 and 1:200,000 leads to perfusion reduction and tissue ischaemia after 30 min, which lasts over 120 min with no significant difference between both formulations. When using Aw/o containing epinephrine in terms of haemostasis for surgical procedures, a prolonged waiting time before incision of 30 or more min can be recommended.

Keywords: contactless; dosage form; hyperaemia; hyperspectral imaging; injection-to-cut-time; ischaemia; non-invasive; same effect; skin perfusion; vasoconstriction.