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OP019 A pilot dose-finding study to counter blood pressure reduction during epidural analgesia by adding epinephrine to the epidural infusion
  1. Olga Nin1,
  2. Andre P Boezaart1,
  3. Christopher Giordano1,
  4. Steven Hughes2,
  5. Hari Parvataneni3,
  6. Miguel Angel Reina4 and
  7. Terrie Vasilopoulos1
  1. 1Anesthesiology, University of Florida, Gainesville, USA
  2. 2Department of Surgery, University of Florida, Gainesville, USA
  3. 3Orthopedic Surgery, University of Florida, Gainesville, USA
  4. 4Anesthesiology, CEU San Pablo School of Medicine, Madrid, Spain


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Background and Aims Epidural analgesia is widely used for perioperative pain management(1,2). An unwanted side effect is the reduction in blood pressure due to the sympathetic blockade. The aim of this study was to evaluate the hemodynamic effect(s) of adding different concentrations of epinephrine to the local anesthetic solution to potentially counteract the sympathectomy(3).

Methods This pilot study was conducted with approval from the Institutional Review Board of University of Florida and informed consent was obtained from all patients. Sixty-six patients were enrolled in a randomized controlled, quadruple-blinded pilot study into three groups (Epidural ropivacaine 0.2% (control), the same local anesthetic agent with either 2 mcg/mL or 5 mcg/mL epinephrine). The study’s primary measurements included mean systolic, diastolic and arterial pressure, arterial blood oxygen saturation, heart rate, respiratory rate, and pain score.

Results A total of 47 patients completed the study (table 1). Fifteen patients were in the control group, 16 patients received 0.2% ropivacaine + 2 mcg/mL epinephrine, and 16 patients received 0.2% ropivacaine + 5 mcg/mL epinephrine. We found significant differences in SBP (p = 0.015) and HR (p = 0.036) for patients who received thoracic epidural blocks (n=26) (figure 1). The control group had much lower SBP compared to the +5mcg/mL epinephrine group; and the +2 mcg/mL epinephrine.

Abstract OP019 Table 1

Demographics and clinical characteristics of the patient sample, stratified by group

Abstract OP019 Figure 1

Lumbar Vs thoracic epidural

Conclusions Adding epinephrine to the epidural local anesthetic agent appeared to prevent the development of low blood pressure in patients who received thoracic blocks. We look forward to expanding our study to increase our sample size and perform primary comparisons stratified by block type.

  • Epidural analgesia
  • Epinephrine
  • Neuraxial block
  • Sympathectomy
  • Hypotension
  • Regional anesthesia
  • Postoperative pain.

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