Epinephrine is not a useful addition to intrathecal fentanyl or fentanyl-bupivacaine for labor analgesia

Stephanie R. Goodman, Susan H. Kim-Lo, Christopher F. Ciliberto, Diane M. Ridley, Richard M. Smiley

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)374-379
Number of pages6
JournalRegional Anesthesia and Pain Medicine
Volume27
Issue number4
DOIs
StatePublished - Jan 1 2002
Externally publishedYes

Fingerprint

Bupivacaine
Fentanyl
Analgesia
Epinephrine
Fetal Heart Rate
Pruritus
Nausea
Incidence
Parturition
Epidural Analgesia
Deceleration
Vomiting
Dilatation
Lower Extremity
Mothers
Blood Pressure
Pain

Keywords

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

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Epinephrine is not a useful addition to intrathecal fentanyl or fentanyl-bupivacaine for labor analgesia. / Goodman, Stephanie R.; Kim-Lo, Susan H.; Ciliberto, Christopher F.; Ridley, Diane M.; Smiley, Richard M.

In: Regional Anesthesia and Pain Medicine, Vol. 27, No. 4, 01.01.2002, p. 374-379.

Research output: Contribution to journalArticle

Goodman, Stephanie R. ; Kim-Lo, Susan H. ; Ciliberto, Christopher F. ; Ridley, Diane M. ; Smiley, Richard M. / Epinephrine is not a useful addition to intrathecal fentanyl or fentanyl-bupivacaine for labor analgesia. In: Regional Anesthesia and Pain Medicine. 2002 ; Vol. 27, No. 4. pp. 374-379.
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