RT Journal Article
SR Electronic
T1 Effect of Epidural Epinephrine Infusion With Bupivacaine on Labor Pain and Mother-Fetus Outcome in Humans
JF Regional Anesthesia & Pain Medicine
JO Reg Anesth Pain Med
FD BMJ Publishing Group Ltd
SP 228
OP 234
DO 10.1053/xr.2000.4149
VO 25
IS 3
A1 Toshiyuki Okutomi
A1 Junko Mochizuki
A1 Kan Amano
A1 Sumio Hoka
YR 2000
UL http://rapm.bmj.com/content/25/3/228.abstract
AB Background and Objectives Epinephrine is used with local anesthetics to prolong the duration of epidural analgesia and decrease the peak plasma concentrations of local anesthetics. In the practice of obstetric anesthesia, the utero-placental and fetal effects of epinephrine are controversial issues. We designed a prospective, randomized, and double-blind study to examine the effects of epinephrine infusion on the quality of analgesia and uterine or umbilical blood flows with Doppler ultrasound, as well as the duration of the first or the second stage of labor, and fetal outcome.Methods Twenty-eight parturients received continuous epidural bupivacaine 0.25% (4 mL/h) combined either with epinephrine (20 μg/h) (n = 13) or without epinephrine (n = 15) for analgesia during labor. If patients requested additional analgesia, an additional bolus of 1% or 1.5% lidocaine (6 to 10 mL) was admimistered.Results The total amount of additional lidocaine was greater in the plain bupivacaine group (130 [0, 280] mg; median [25th, 75th percentile] with P < .05) than in the epinephrine group (0 [0, 60] mg). Epinephrine infusion did not alter the resistance of the uterine and umbilical arteries as measured by resistance index. The duration of the first or second stages of labor did not significantly differ in the 2 groups. Epinephrine infusion did not change the fetal heart rate or the blood gas data in the umbilical artery.Conclusions A low-dose epidural infusion of epinephrine decreased anesthetic requirements.