title: The effect of a priming epidural injection of adrenaline on epidural blockade with bupivacaine.
abstract: Twenty-four patients receiving epidural anaesthesia were studied to test the hypothesis that 1:200,000 adrenaline administered into the epidural space 5 minutes before 20 ml bupivacaine 0.5% would improve nerve block and delay systemic absorption of the local anaesthetic. Group A/B received 20 ml adrenaline 1:200,000 5 minutes before 20 ml bupivacaine 0.5%, group S/BA 20 ml saline followed by 20 ml bupivacaine 0.5% with 100 micrograms adrenaline, and group S/B saline 20 ml followed by 20 ml plain bupivacaine 0.5%. Mean maximum plasma concentrations of bupivacaine tended to be lower in the adrenaline groups. A delay in the time to peak plasma concentration of bupivacaine was noted in the A/B group; this indicated that priming with adrenaline may be effective at delaying early systemic uptake of the local anaesthetic. In both adrenaline groups a more prolonged epidural block and increased efficacy were noted, although this was only significant for the duration of block at T6 (p = 0.023) and duration of motor block at Bromage level 1 (p = 0.016) in group A/B. There seems little clinical advantage in administering adrenaline 5 minutes before bupivacaine.
authors.affiliation: Department of Physiology, St. Thomas' Hospital, London.
authors.forename: A P
authors.initials: AP
authors.lastname: Baranowski
authors.forename: Y
authors.initials: Y
authors.lastname: Dean
authors.forename: C E
authors.initials: CE
authors.lastname: Pither
mesh_terms: D000767:Anesthesia, Epidural; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D004311:Double-Blind Method; D004347:Drug Interactions; D004837:Epinephrine / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons / Q000187:drug effects; D011674:Pulse / Q000187:drug effects; D012677:Sensation / Q000187:drug effects; D013997:Time Factors
chemical_list: D002045:Bupivacaine; D004837:Epinephrine