title: Epinephrine 4 microg/mL added to a low-dose mixture of ropivacaine and fentanyl for lumbar epidural analgesia after total knee arthroplasty.
abstract: BACKGROUND
  Epinephrine 2 microg/mL added to a local anesthetic-opioid mixture has been found to improve postoperative continuous epidural analgesia at the thoracic (TEA) but not at lumbar (LEA) level. Therefore, we studied whether a higher dose of epinephrine could improve LEA.
  
  
  METHODS
  Patients received LEA comprising of ropivacaine 1.8 mg/mL and fentanyl 3 microg/mL either without (group RF, n = 32) or with epinephrine 4 microg/mL (group RFE, n = 31) for 2 days after total knee arthroplasty. Rescue pain medication consisted of epidural top-ups (study mixture) and parenteral oxycodone.
  
  
  RESULTS
  Total amounts of epidurally administered drugs were significantly higher in group RFE. Otherwise, the groups did not differ significantly regarding pain relief and side effects.
  
  
  CONCLUSIONS
  As part of the multimodal pain treatment used, the epidural adjuvant epinephrine 4 microg/mL (12-32 microg/h) did not improve LEA after total knee arthroplasty.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Finland. johannes.forster@hus.fi
authors.forename: Johannes G
authors.initials: JG
authors.lastname: Förster
authors.forename: Hilkka M
authors.initials: HM
authors.lastname: Lumme
authors.forename: Vilja J
authors.initials: VJ
authors.lastname: Palkama
authors.forename: Per H
authors.initials: PH
authors.lastname: Rosenberg
authors.forename: Mikko T
authors.initials: MT
authors.lastname: Pitkänen
mesh_terms: D000368:Aged; D000577:Amides / Q000008:administration & dosage / Q000627:therapeutic use*; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D010098:Oxycodone / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D000077212:Ropivacaine; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D010098:Oxycodone; D005283:Fentanyl; D004837:Epinephrine