title: Addition of epinephrine to intrathecal bupivacaine and sufentanil for ambulatory labor analgesia.
abstract: BACKGROUND
  The intrathecal combination of sufentanil and bupivacaine provides rapid, effective analgesia for labor with a limited duration. Many anesthesiologists have concerns that the use of intrathecal local anesthetics precludes maternal ambulation. This prospective, randomized, double-blind study was designed to determine whether the addition of epinephrine to the combination of sufentanil and bupivacaine would prolong intrathecal analgesia for labor. Patients' ability to ambulate was also assessed.
  
  
  METHODS
  Thirty-nine patients received either an intrathecal control dose of 10 micrograms sufentanil plus 2.5 mg bupivacaine plus 0.2 ml normal saline (control group); or 10 micrograms sufentanil plus 2.5 mg bupivacaine plus 0.2 ml (0.2 mg) of epinephrine (EPI group).
  
  
  RESULTS
  Seven patients (3 control, 4 EPI) delivered vaginally and two (1 control, 1 EPI) required cesarean delivery before requesting epidural analgesia. The duration (mean +/- SD) of intrathecal labor analgesia was prolonged significantly by the addition of epinephrine: control (n = 15): 145 +/- 23 min; EPI (n = 15): 188 +/- 25 min (P < 0.0001). Maternal ambulation was demonstrated in 100% (19 of 19) of the control group and in 80% (16 of 20) of the EPI group (P = NS).
  
  
  CONCLUSIONS
  The addition of 0.2 mg epinephrine to the intrathecal combination of sufentanil and bupivacaine significantly prolonged labor analgesia without causing adverse effects to the mother or fetus. The intrathecal combination of sufentanil and bupivacaine, with or without epinephrine, provided rapid, profound labor analgesia and allowed most patients to ambulate.
authors.affiliation: Department of Anaesthesia, Royal University Hospital, University of Saskatchewan, Saskatoon, Canada.
authors.forename: D C
authors.initials: DC
authors.lastname: Campbell
authors.forename: R
authors.initials: R
authors.lastname: Banner
authors.forename: L A
authors.initials: LA
authors.lastname: Crone
authors.forename: W
authors.initials: W
authors.lastname: Gore-Hickman
authors.forename: R W
authors.initials: RW
authors.lastname: Yip
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods*; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D002045:Bupivacaine; D004311:Double-Blind Method; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D004837:Epinephrine; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D007743:Labor, Obstetric; D011247:Pregnancy; D011446:Prospective Studies; D017409:Sufentanil
chemical_list: D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D017409:Sufentanil; D002045:Bupivacaine; D004837:Epinephrine