title: Epinephrine adjuvant reduced epidural blood vessel penetration incidence in a randomized, double-blinded trial.
abstract: BACKGROUND
  Accidental intravascular injection is a significant and potentially devastating risk of epidural block, particularly in parturients whose epidural veins are engorged and hence more easily pierced. This prospective randomized, double-blinded study determined whether the addition of epinephrine to epidural ropivacaine administered by gravity before catheter insertion was associated with fewer epidural catheter blood vessel penetrations.
  
  
  METHODS
  Four hundred and two parturient patients receiving epidural block for elective C/S were randomly allocated to two groups; group I (n = 201) received only ropivacaine 0.75% with fentanyl 5 μg/mL, whereas group II (n = 200) also received epinephrine 5 μg/mL. Both groups received a total of 21 mL anesthetic solution in four increment doses of 3,5,5,5 mL by gravity into the needle through a 22 inch extension tubing before insertion of the closed-end tip catheter. An additional 3 mL of the anesthetic solution was then administered through the catheter.
  
  
  RESULTS
  Epidural epinephrine adjuvant was associated with fewer epidural vessel penetrations (4% vs. 16.5%, P < 0.0001). The addition of epinephrine also significantly reduced catheter insertion problems (12% vs. 23.5%, P-value 0.0024) including the need for catheter readjustment (4.5% vs. 16%, P-value 0.0002) or reinsertion (2.5% vs. 9%, P-value 0.0054). The addition of epinephrine significantly reduced incidence and severity of sedation and had faster onset of surgical block. Sensory level and overall satisfaction did not differ significantly among the groups.
  
  
  CONCLUSIONS
  The addition of epinephrine to ropivacaine improves the safety and quality of epidural anesthesia when administered by gravity flow via the Hustead needle for cesarean sections.
authors.affiliation: Department of Anesthesiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Denny
authors.affiliation: Department of Anesthesiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
authors.forename: S
authors.initials: S
authors.lastname: Cohen
authors.affiliation: Department of Anesthesiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Stein
authors.affiliation: Department of Anesthesiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
authors.forename: T
authors.initials: T
authors.lastname: Banerjee
authors.affiliation: Department of Anesthesiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
authors.forename: R
authors.initials: R
authors.lastname: Naftalovich
authors.affiliation: Department of Anesthesiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
authors.forename: C W
authors.initials: CW
authors.lastname: Hunter-Fratzola
mesh_terms: D000328:Adult; D000577:Amides / Q000008:administration & dosage; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods*; D002585:Cesarean Section; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D020073:Gravidity; D006801:Humans; D015994:Incidence; D011247:Pregnancy; D011446:Prospective Studies; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000077212:Ropivacaine; D004837:Epinephrine