title: Does the choice of local anesthetic affect the catecholamine response to stress during epidural anesthesia?
abstract: BACKGROUND
  Previous work has established that 2-chloroprocaine epidural anesthesia has no effect on circulating plasma epinephrine concentrations in young, healthy, resting volunteers, and results in a decrease in norepinephrine concentration only when a level of analgesia to pinprick of C-8 is reached. The current study was performed to evaluate the possibility that this finding is unique to 2-chloroprocaine.
  
  
  METHODS
  Nine healthy volunteers were studied on three occasions at least 48 h apart; each received three local anesthetics (0.75% bupivacaine, 2% lidocaine, and 3% 2-chloroprocaine, all without epinephrine). After placement of lumbar epidural and central venous catheters, blood samples were drawn from the central venous catheter at the following stages: (1) 20 min after catheter placement (baseline), (2) during the first cold pressor test (CPT; hand held in an ice water bath for 90 s), (3) 20 min after reaching epidural analgesia to T-1 level of analgesia, and (4) during a second CPT (epidural analgesia to T-1). Monitoring consisted of noninvasive cardiac output (impedance), noninvasive blood pressure, and EKG.
  
  
  RESULTS
  Extensive epidural block (stage 3) altered measured variables only minimally with respect to resting baseline state. During stage 2 (first CPT), mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), epinephrine, and norepinephrine increased. During stage 4 (second CPT), increases in HR and CI were not attenuated by any of the three local anesthetics. Increases in MAP were attenuated by epidural anesthesia with all three local anesthetics. Bupivacaine and 2-chloroprocaine epidural anesthesia significantly attenuated increases in plasma catecholamines, but lidocaine epidural anesthesia did not.
  
  
  CONCLUSIONS
  Epidural anesthesia with all three local anesthetic agents tested resulted in an incomplete sympathectomy in the resting state in healthy young men, judged by plasma catecholamine concentrations and cardiovascular variables minimally changed from resting baseline. Lidocaine epidural anesthesia did not attenuate the catecholamine response to CPT, indicating decreased blockade of sympathetic efferent neural traffic compared with bupivacaine and chloroprocaine epidural anesthesia.
authors.affiliation: Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: R A
authors.initials: RA
authors.lastname: Stevens
authors.forename: D
authors.initials: D
authors.lastname: Beardsley
authors.forename: J L
authors.initials: JL
authors.lastname: White
authors.forename: T C
authors.initials: TC
authors.lastname: Kao
authors.forename: P J
authors.initials: PJ
authors.lastname: Teague
authors.forename: L
authors.initials: L
authors.lastname: Spitzer
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000494:pharmacology*; D002045:Bupivacaine; D002395:Catecholamines / Q000097:blood*; D003080:Cold Temperature; D006339:Heart Rate; D006801:Humans; D008012:Lidocaine; D008297:Male; D011343:Procaine / Q000031:analogs & derivatives; D013312:Stress, Physiological / Q000097:blood*
chemical_list: D000779:Anesthetics, Local; D002395:Catecholamines; D011343:Procaine; C004616:chloroprocaine; D008012:Lidocaine; D002045:Bupivacaine