Addition of epinephrine to epidural bupivacaine infusions following initiation of labor analgesia with epidural fentanyl
STUDY OBJECTIVE: To evaluate the analgesic effects of the addition of epinephrine to a bupivacaine epidural infusion in early labor after a fentanyl bolus, following a lidocaine-epinephrine test dose. DESIGN: Randomized, double-blinded study. SETTING: Labor suite of a tertiary care hospital. PATIENTS: 60 ASA physical status 1 and 2, laboring, nulliparous women. INTERVENTIONS: All laboring women received a 3 mL epidural test dose of 1.5% lidocaine with 1:200,000 epinephrine, followed by a fentanyl 100 Î¼g bolus in 10 mL of diluent volume. Patients were randomized to receive one of two continuous epidural infusions: bupivacaine 0.625 mg/mL at 10 mL/hr (control group) or bupivacaine 0.625 mg/mL with epinephrine 5 Î¼g/mL at 10 mL/hr (epinephrine group). MEASUREMENTS: Time to re-dose, pain scores, and side effects were recorded. MAIN RESULTS: The mean duration of satisfactory analgesia prior to re-dose was 159 Â± 62 min for the control group and 221 Â± 111 min for the epinephrine group (P < 0.02). Pain scores were significantly higher in the control group than the epinephrine group at two time periods: 2.5 hours and 4.5 hours (P < 0.04). CONCLUSIONS: The administration of 0.625 mg/mL bupivacaine with epinephrine 5 Î¼g/mL at 10 mL/hr, compared with plain 0.625 mg/mL bupivacaine at 10 mL/hr, provided a longer time to re-dose, decreased pain scores at two time intervals, and had no significant difference in duration of labor or side effects. Copyright Â© 2011 Elsevier Inc. All rights reserved.
Connelly NR, Freiman JP, Lucas T, Parker RK, Raghunathan K, Gibson C, Katz B, Iwashita C. Addition of epinephrine to epidural bupivacaine infusions following initiation of labor analgesia with epidural fentanyl J Clin Anesth 2011 Jun;23(4):265-9.