Changes in human plasma catecholamine concentrations during epidural anesthesia depend on the level of block.
To test the hypothesis that increasing levels of epidural analgesia will produce progressive decreases in circulating catecholamines, we sequentially produced three levels of analgesia, T8, T4, and C8, to pin prick in young, healthy volunteers. Three percent chloroprocaine (plain) was used as the local anesthetic. The epidural analgesia was allowed to dissipate following the T8 and T4 levels of block. After the C8 level the block was reinforced to study the effect of a "top-up" dose. Blood samples were drawn from a central venous catheter. Plasma concentrations of norepinephrine and epinephrine were determined by the single isotope radioenzymatic method. Despite extensive block, hemodynamic alterations were minimal, and no significant decrease in plasma epinephrine was observed as the level of analgesia was raised to the C8 dermatome. When the level of analgesia was raised above T8, there was a trend for norepinephrine to decrease, but this decrease did not become statistically significant until analgesia reached the C8 dermatome. Reinforcing the epidural block at the C8 level of analgesia resulted an insignificant decrease in epinephrine and norepinephrine NE. Under the conditions of the present study, epidural block with a sensory analgesia level as high as C8 did not significantly decrease the plasma concentration of epinephrine in unstressed volunteers. The plasma concentration of norepinephrine significantly decreased only when the level of sensory analgesia was approximately C8.
Stevens
R A
RA
Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Artuso
J D
JD
Kao
T C
TC
Bray
J G
JG
Spitzer
L
L
Louwsma
D L
DL
D000328:Adult; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local; D004837:Epinephrine / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D009638:Norepinephrine / Q000097:blood*; D011343:Procaine / Q000031:analogs & derivatives*
D000779:Anesthetics, Local; D011343:Procaine; C004616:chloroprocaine; D009638:Norepinephrine; D004837:Epinephrine