title: The effect of intrathecal epinephrine on epidural infused analgesics during labor.
abstract: OBJECTIVE
  In order to prolong labor analgesia, one may add intrathecal epinephrine to the combination of bupivacaine and fentanyl. In this study, we tested the hypothesis that the addition of intrathecal epinephrine would lessen the requirement for a rescue dose of epidural analgesia during labor.
  
  
  METHODS
  One hundred-eight parturients randomly received intrathecal bupivacaine 2.5 mg and fentanyl 25 microgram with epinephrine 100 microgram (Group BFE) or without (Group BF). Analgesia was assessed by visual analogue pain score (VAPS) 15 and 30 minutes after drug administration. Then, epidural analgesia (0.1% bupivacaine with 0.0002% fentanyl and 1:250,000 epinephrine at 10 mL/h) was initiated. If the patient requested additional analgesia and VAPS was over 30 mm, we added 8 mL epidural bupivacaine 0.125%. The requirement for additional analgesia, the incidence of motor block assessed by a modified Bromage score, hypotension, nausea, and pruritus was noted.
  
  
  RESULTS
  Except for 3 parturients in Group BF, satisfactory analgesia was achieved in all parturients 30 minutes after intrathecal drug administration. Following 30 minutes of intrathecal drug administration, VAPSs (mean +/- SD) were 0 +/- 4 mm in Group BFE and 4 +/- 11 mm in Group BF. The number of patients who required additional labor analgesia in Group BFE (11 patients, 20%) was significantly less than in Group BF (26 patients, 48%) (P =.003). The incidence of motor block 30 minutes after spinal analgesia in Group BFE (12 patients, 22%) was significantly higher than in Group BF (3 patients, 6%) (P =.024). Nausea and pruritus were similar in both groups.
  
  
  CONCLUSIONS
  The addition of epinephrine to intrathecal bupivacaine-fentanyl lessened the requirement for additional epidural analgesia without increasing hypotension, nausea, or pruritus. However, the incidence of motor block may be increased without labor prolongation.
authors.affiliation: Departments of Anesthesiology, Kitasato University School of Medicine, Kanagawa, Japan. toshiyukiokutomi@hotmail.com
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Okutomi
authors.forename: Junko
authors.initials: J
authors.lastname: Mochizuki
authors.forename: Kan
authors.initials: K
authors.lastname: Amano
authors.forename: Sanjay
authors.initials: S
authors.lastname: Datta
mesh_terms: D000759:Adjuvants, Anesthesia; D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000779:Anesthetics, Local; D002045:Bupivacaine; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D005283:Fentanyl; D006801:Humans; D007278:Injections, Spinal; D007743:Labor, Obstetric; D010147:Pain Measurement; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011247:Pregnancy; D011537:Pruritus / Q000139:chemically induced / Q000453:epidemiology; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D005283:Fentanyl; D002045:Bupivacaine; D004837:Epinephrine