title: Effects of epinephrine in the epidural space on the incidence of blood vessel injury by epidural catheter insertion for cesarean section: a prospective, randomized, double-blind study.
abstract: OBJECTIVE
  To evaluate the effects of epinephrine (1:200,000) in the epidural space on the incidence of blood vessel injury by epidural catheter insertion for cesarean section.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  University-affiliated teaching hospital.
  
  
  METHODS
  Four hundred laboring women with singleton cephalic presentations at term who underwent cesarean section and requested continuous epidural analgesia.
  
  
  METHODS
  Predistension of 5 mL of isotonic sodium chloride solution containing epinephrine (1:200,000) or 5 mL of isotonic sodium chloride solution through an epidural needle before catheter insertion.
  
  
  METHODS
  Cases with bloody fluid in the epidural needle or catheter during catheter insertion, aspiration of frank blood from the epidural catheter, and blood noted in the caudal end of the epidural catheter upon removal were recorded.
  
  
  RESULTS
  Eight parturients were excluded from the analysis for technical reasons. There were no significant differences between patients in the 2 groups with respect to cases with bloody fluid in the epidural needle during catheter insertion (7.6% vs 9.8%, P = .44), the epidural catheter during catheter placement (6.0% vs 6.7%, P = .80), aspiration of frank blood in the epidural catheter (1.0% vs 1.0 %, P = .98), and blood noted in the caudal end of the epidural catheter upon removal (27.3% vs 30.4 %; P > .49).
  
  
  CONCLUSIONS
  Twenty-five micrograms of epinephrine (1:200,000) in the epidural space does not reduce the incidence of blood vessel injury induced by insertion of an epidural catheter.
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China. Electronic address: mzhcb@126.com.
authors.forename: Chuanbao
authors.initials: C
authors.lastname: Han
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Qinhai
authors.initials: Q
authors.lastname: Zhou
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Zhengnian
authors.initials: Z
authors.lastname: Ding
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Yanning
authors.initials: Y
authors.lastname: Qian
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods; D000773:Anesthesia, Obstetrical / Q000379:methods; D002404:Catheterization / Q000009:adverse effects* / Q000379:methods; D002585:Cesarean Section / Q000379:methods*; D004311:Double-Blind Method; D004824:Epidural Space; D004837:Epinephrine / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006801:Humans; D015994:Incidence; D009339:Needles; D011247:Pregnancy; D011446:Prospective Studies; D057772:Vascular System Injuries / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
chemical_list: D004837:Epinephrine
keywords: Anesthesia; Cesarean section; Epidural; Epinephrine; Hematoma