Article Text

Download PDFPDF
Pilot epinephrine dose-finding study to counter epidural-related blood pressure reduction
  1. Olga C Nin1,
  2. Andre Boezaart1,2,
  3. Christopher Giordano1,
  4. Steven J Hughes3,
  5. Hari K Parvataneni4,
  6. Miguel A Reina1,5,
  7. Abigail Schirmer1 and
  8. Terrie Vasilopoulos1,2
  1. 1Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
  2. 2Orthopaedics and Sports Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
  3. 3Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
  4. 4Florida Orthopaedic Institute, Gainesville, Florida, USA
  5. 5CEU San Pablo University School of Medicine, Madrid, Spain
  1. Correspondence to Dr Olga C Nin, Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA; onin{at}


Objective An unwanted side effect associated with epidural analgesia is the reduction in blood pressure (BP) due to the sympathetic blockade. This study evaluated the hemodynamic effects of adding different epinephrine concentrations to epidurally injected local anesthetic solution to counteract sympathectomy. We hypothesized that epinephrine could mitigate the decrease in BP possibly caused by the local anesthetic, specifically decreasing the incidence of hypotension.

Methods Sixty-six patients were enrolled in a randomized, controlled, quadruple-blinded prospective study into three groups: epidural ropivacaine 0.2% without epinephrine (control) or with 2 µg/mL or 5 µg/mL epinephrine. Our primary outcome was the assessment of differences in hypotension between groups, defined as a >20% decrease in hypotension from baseline to the end of the intraoperative period.

Results Forty-seven patients completed the study, and 19 were withdrawn. Fifteen patients were in the control group, while 16 patients received 0.2% ropivacaine +2 µg/mL epinephrine, and 16 received 0.2% ropivacaine +5 µg/mL epinephrine. The overall rate of hypotension was 21.3% (10/47). There were no statistically significant differences in hypotension rates between the control group (33%) and groups receiving either +2 µg/mL (13%, p=0.165) or +5 µg/mL (19%, p=0.353) of epinephrine. In secondary analyses, respiratory rate showed greater decreases in control groups across the perioperative period compared with treatment groups (p=0.016)

Conclusion Adding epinephrine to the epidural local anesthetic did not significantly decrease the rate of hypotension. However, epinephrine mitigated decreases in respiratory rate across the perioperative period. Future studies will focus on increasing group size and higher epinephrine concentrations (10 µg/mL).

Trial registration number NCT02722746.

  • analgesia
  • Autonomic Nerve Block
  • Nerve Block

Data availability statement

No data are available.

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.


  • X @aboezaart1

  • Contributors OCN: guarantor, conceptualization, methodology, investigation, writing—original draft, writing—review and editing, funding acquisition; AB: conceptualization, methodology, writing—review and editing; CG, HKP: methodology, investigation, writing—review and editing; SJH, MAR: methodology, writing—review and editing; AS: writing—review and editing; TV: formal analysis, writing—original draft, writing—review and editing, visualization.

  • Funding This study was financially supported by the Department of Anesthesiology of the University of Florida and by the I. Heermann Anesthesia Foundation (IHAF).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.