Addition of epinephrine to epidural bupivacaine infusions following initiation of labor analgesia with epidural fentanyl.

Journal Article (Journal Article)

STUDY 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. DESIGN: Randomized, double-blinded study. SETTING: Labor suite of a tertiary care hospital. PATIENTS: 60 ASA physical status 1 and 2, laboring, nulliparous women. INTERVENTIONS: 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). MEASUREMENTS: Time to re-dose, pain scores, and side effects were recorded. MAIN 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.

Full Text

Duke Authors

Cited Authors

  • Connelly, NR; Freiman, JP; Lucas, T; Parker, RK; Raghunathan, K; Gibson, C; Katz, B; Iwashita, C

Published Date

  • June 2011

Published In

Volume / Issue

  • 23 / 4

Start / End Page

  • 265 - 269

PubMed ID

  • 21489769

Electronic International Standard Serial Number (EISSN)

  • 1873-4529

Digital Object Identifier (DOI)

  • 10.1016/j.jclinane.2010.09.005


  • eng

Conference Location

  • United States