TY - JOUR
T1 - Epinephrine is not a useful addition to intrathecal fentanyl or fentanyl-bupivacaine for labor analgesia
AU - Goodman, Stephanie R.
AU - Kim-Lo, Susan H.
AU - Ciliberto, Christopher F.
AU - Ridley, Diane M.
AU - Smiley, Richard M.
N1 - Funding Information:
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. Accepted for publication January 21, 2002. 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. 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@columbia.edu © 2002 by the American Society of Regional Anesthesia and Pain Medicine. 1098-7339/02/2704-0005$35.00/0 doi:10.1053/rapm.2002.33283
PY - 2002
Y1 - 2002
N2 - 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.
AB - 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.
KW - Anesthesia
KW - Combined spinal and epidural
KW - Epinephrine
KW - Labor
KW - Obstetrics
KW - Pain
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U2 - 10.1053/rapm.2002.33283
DO - 10.1053/rapm.2002.33283
M3 - Article
C2 - 12132061
AN - SCOPUS:0036077004
SN - 1098-7339
VL - 27
SP - 374
EP - 379
JO - Regional anesthesia and pain medicine
JF - Regional anesthesia and pain medicine
IS - 4
ER -