Article Text

Download PDFPDF
Epinephrine is Not a Useful Addition to Intrathecal Fentanyl or Fentanyl-Bupivacaine for Labor Analgesia
  1. Stephanie R. Goodman, M.D.,
  2. Susan H. Kim-Lo, M.D.,
  3. Christopher F. Ciliberto, M.D.,
  4. Diane M. Ridley, M.D. and
  5. Richard M. Smiley, M.D., Ph.D.
  1. From the Department of Anesthesiology, Columbia University College of Physicians and Surgeons (S.R.G., S.H.K-L., C.F.C., R.M.S.), New York, New York; and Elmhurst Hospital Center (D.M.R.), Queens, New York.
  1. Reprint requests: Stephanie R. Goodman, M.D., Columbia University College of Physicians and Surgeons, 630 West 168th St, PH-5, New York, NY 10032. E-mail: srg24{at}


Background and Objectives Intrathecal fentanyl provides effective labor analgesia for a limited time with frequent side effects. We evaluated the effects of adding epinephrine to intrathecal fentanyl with and without bupivacaine.

Methods Eighty healthy, term, nulliparous parturients with cervical dilation of 5 cm or less received combined spinal-epidural (CSE) analgesia. Subjects were randomized in a double-blind fashion to 1 of 4 intrathecal solutions containing fentanyl 35 μg with either saline (F); bupivacaine 2.5 mg + saline (FB); bupivacaine 2.5 mg + epinephrine 100 μg (FBE); or epinephrine 100 μg + saline (FE). Patients were evaluated for visual analog pain score, duration of spinal analgesia (time until patient request for additional analgesia), nausea/vomiting, pruritus, sensory and motor block, maternal blood pressure, and fetal heart rate (FHR).

Results Intrathecal bupivacaine significantly prolonged fentanyl analgesia with or without epinephrine (P = .018), but epinephrine did not significantly prolong the duration of fentanyl alone or with bupivacaine (F, 92 ± 39 minutes; FB, 125 ± 31 minutes; FBE, 134 ± 42 minutes; and FE, 117 ± 48 minutes). Intrathecal epinephrine was associated with a higher incidence of severe nausea (P = .001), and the FBE group had more lower extremity weakness (P = .047). There was no difference in the incidence of severe pruritus, FHR deceleration, or delivery outcome between the groups.

Conclusions These results suggest that intrathecal epinephrine does not prolong the duration of fentanyl or fentanyl with bupivacaine for labor analgesia in nulliparous parturients. Additionally, intrathecal epinephrine did not decrease the incidence of side effects and therefore cannot be recommended.

  • Anesthesia
  • Combined spinal and epidural
  • Epinephrine
  • Labor
  • Obstetrics
  • Pain

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Supported in part by a gift from Becton Dickinson (Franklin Lakes, NJ) and a House Staff Research Award from Presbyterian Hospital (New York, NY).

    Work performed in the Department of Anesthesiology, Columbia University College of Physicians and Surgeons.

    Presented at the Annual Meeting of the Society for Obstetric Anesthesia and Perinatology, April 29, 1998, Vancouver, BC, Canada and the Annual Meeting of the American Society of Anesthesiology, October 17, 1998, Orlando, FL.