Lasting Effects of Surgically Used Topical Vasodilators on DIEP Artery Vascular Function

Jason S. Kofoed; Fatma B. Tuncer; Alvin C. Kwok; Jayant P. Agarwal; Bradley A. Ruple; Marta Borrelli; J. David Symons; Russell S. Richardson; Ryan M. Broxterman

doi:10.1055/s-0044-1788326

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2025; 41(03): 219-226
DOI: 10.1055/s-0044-1788326

Original Article

Lasting Effects of Surgically Used Topical Vasodilators on DIEP Artery Vascular Function

Authors

Jason S. Kofoed

¹Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
Fatma B. Tuncer

²Department of Surgery, University of Utah, Salt Lake City, Utah
Alvin C. Kwok

²Department of Surgery, University of Utah, Salt Lake City, Utah
Jayant P. Agarwal

²Department of Surgery, University of Utah, Salt Lake City, Utah
Bradley A. Ruple

³Department of Internal Medicine, University of Utah, Salt Lake City, Utah

⁴Geriatric Research, Education, and Clinical Center, VA Medical Center, Salt Lake City, Utah
Marta Borrelli

¹Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah

⁵Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
J. David Symons

¹Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah

⁶Division of Endocrinology, Metabolism and Diabetes, Program in Molecular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Russell S. Richardson

¹Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah

³Department of Internal Medicine, University of Utah, Salt Lake City, Utah

⁴Geriatric Research, Education, and Clinical Center, VA Medical Center, Salt Lake City, Utah
Ryan M. Broxterman

¹Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah

³Department of Internal Medicine, University of Utah, Salt Lake City, Utah

⁴Geriatric Research, Education, and Clinical Center, VA Medical Center, Salt Lake City, Utah

Abstract

Background Surgeons routinely apply papaverine, lidocaine, or verapamil to produce acute vasodilation and prevent vasospasms during microvascular surgeries. There is evidence that topical vasodilators may induce postoperative endothelial and smooth muscle dysfunction, which would present after the acute vasodilatory effects of the topical drugs wear off. Therefore, the purpose of the current study was to evaluate the lasting effects of papaverine, lidocaine, and verapamil on human deep inferior epigastric perforator artery vasodilatory function after the acute effects of the topical drugs had worn off.

Methods Deep inferior epigastric arterial samples were obtained from 12 patients during surgery. Each artery was dissected into four rings which where incubated for 1 minute in either physiological saline solution (control), papaverine (30 mg/mL), lidocaine (20 mg/mL), or verapamil (2.5 mg/mL), followed by a 2-hour washout. Endothelial-dependent and -independent vasorelaxation were then assessed by the isometric tension responses to acetylcholine or sodium nitroprusside, respectively.

Results Peak acetylcholine-evoked vasorelaxation (mean ± standard deviation) was not different between control (62 ± 23%) and lidocaine (57 ± 18%, p = 0.881), but was reduced (all p < 0.002) in papaverine (22 ± 27%) and verapamil (22 ± 20%). Peak sodium nitroprusside-evoked vasorelaxation was not different (all p > 0.692) among control (132 ± 35%), lidocaine (121 ± 22%), and verapamil (127 ± 22%), but was less in papaverine (104 ± 41%; p = 0.045) than control.

Conclusion Surgically used doses of papaverine and verapamil, but not lidocaine, have lasting negative effects on arterial vasodilatory function despite the acute effects of the drugs having worn off. These findings, in conjunction with the spasmolytic properties of each drug, may help guide the selection of an optimal topical vasodilator for use during microvascular surgeries.

Keywords

papaverine - verapamil - lidocaine

Volltext

Referenzen

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