title: Local infiltration of epinephrine-containing lidocaine with bicarbonate reduces superficial bleeding and pain during labor epidural catheter insertion: a randomized trial.
abstract: BACKGROUND
  Superficial bleeding after labor epidural catheter placement is a common phenomenon. In addition to delaying securing the epidural catheter, it may loosen the adhesive catheter dressing. The primary aim of this study was to determine whether skin infiltration with epinephrine-containing rather than plain lidocaine reduces superficial bleeding after catheter placement. Secondary objectives were to determine whether adding epinephrine and/or sodium bicarbonate affected infiltration pain.
  
  
  METHODS
  After institutional review board approval and informed consent, 80 healthy women receiving epidural analgesia during labor were randomly assigned in a double-blind manner to four local anesthetic mixtures (n=20 in each group): group L: lidocaine 1.5%, group LB: lidocaine 1.5% with 8.4% sodium bicarbonate, group LE: lidocaine 1.5% with epinephrine 1:200000, and group LEB: lidocaine 1.5% with epinephrine 1:200000 and 8.4% sodium bicarbonate. Clinical endpoints included the amount of superficial bleeding at the catheter site, pain during local anesthetic infiltration and epidural catheter movement during labor.
  
  
  RESULTS
  Demographic data were similar among the groups. The addition of epinephrine to lidocaine significantly reduced superficial bleeding. Solutions containing epinephrine were well tolerated and caused no cardiovascular disturbances. The addition of epinephrine did not increase pain, while bicarbonate reduced it [verbal score (scale 0-10) 3.6+/-2.2 vs. 2.6+/-1.8; P=0.04]. There were no differences in epidural catheter movement among the groups; no catheters became displaced during labor.
  
  
  CONCLUSIONS
  Local infiltration of epinephrine-containing lidocaine before epidural catheter insertion reduces superficial bleeding and the addition of bicarbonate decreases pain during skin infiltration.
authors.affiliation: Department of Anesthesia, Stanford University School of Medicine, Stanford, California 94305, USA. bcarvalho@stanford.edu
authors.forename: B
authors.initials: B
authors.lastname: Carvalho
authors.forename: A
authors.initials: A
authors.lastname: Fuller
authors.forename: C
authors.initials: C
authors.lastname: Brummel
authors.forename: S E
authors.initials: SE
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D002404:Catheterization / Q000009:adverse effects; D004311:Double-Blind Method; D004338:Drug Combinations; D004837:Epinephrine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control*; D006801:Humans; D007268:Injections, Epidural; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control*; D011247:Pregnancy; D011446:Prospective Studies; D012016:Reference Values; D017693:Sodium Bicarbonate / Q000008:administration & dosage* / Q000009:adverse effects; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000779:Anesthetics, Local; D004338:Drug Combinations; D014662:Vasoconstrictor Agents; D017693:Sodium Bicarbonate; D008012:Lidocaine; D004837:Epinephrine