title: Addition of epinephrine to epidural bupivacaine infusions following initiation of labor analgesia with epidural fentanyl.
abstract: OBJECTIVE
  To evaluate the analgesic effects of the addition of epinephrine to a bupivacaine epidural infusion in early labor after a fentanyl bolus, following a lidocaine-epinephrine test dose.
  
  
  METHODS
  Randomized, double-blinded study.
  
  
  METHODS
  Labor suite of a tertiary care hospital.
  
  
  METHODS
  60 ASA physical status 1 and 2, laboring, nulliparous women.
  
  
  METHODS
  All laboring women received a 3 mL epidural test dose of 1.5% lidocaine with 1:200,000 epinephrine, followed by a fentanyl 100 μg bolus in 10 mL of diluent volume. Patients were randomized to receive one of two continuous epidural infusions: bupivacaine 0.625 mg/mL at 10 mL/hr (control group) or bupivacaine 0.625 mg/mL with epinephrine 5 μg/mL at 10 mL/hr (epinephrine group).
  
  
  METHODS
  Time to re-dose, pain scores, and side effects were recorded.
  
  
  RESULTS
  The mean duration of satisfactory analgesia prior to re-dose was 159 ± 62 min for the control group and 221 ± 111 min for the epinephrine group (P < 0.02). Pain scores were significantly higher in the control group than the epinephrine group at two time periods: 2.5 hours and 4.5 hours (P < 0.04).
  
  
  CONCLUSIONS
  The administration of 0.625 mg/mL bupivacaine with epinephrine 5 μg/mL at 10 mL/hr, compared with plain 0.625 mg/mL bupivacaine at 10 mL/hr, provided a longer time to re-dose, decreased pain scores at two time intervals, and had no significant difference in duration of labor or side effects.
authors.affiliation: Department of Anesthesiology, Baystate Medical Center, Springfield, MA 01199, USA. neil.roy.connelly@bhs.org
authors.forename: Neil Roy
authors.initials: NR
authors.lastname: Connelly
authors.forename: Jorge P
authors.initials: JP
authors.lastname: Freiman
authors.forename: Tanya
authors.initials: T
authors.lastname: Lucas
authors.forename: Robert K
authors.initials: RK
authors.lastname: Parker
authors.forename: Karthik
authors.initials: K
authors.lastname: Raghunathan
authors.forename: Charles
authors.initials: C
authors.lastname: Gibson
authors.forename: Brennan
authors.initials: B
authors.lastname: Katz
authors.forename: Chad
authors.initials: C
authors.lastname: Iwashita
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011247:Pregnancy; D013997:Time Factors; D055815:Young Adult
chemical_list: D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D008012:Lidocaine; D005283:Fentanyl; D002045:Bupivacaine; D004837:Epinephrine