Effects of Extradural Bupivacaine With Adrenaline for Caesarean Section on Uteroplacental and Fetal Circulation

Alahuhta, Seppo; Räsänen, Juha; Jouppila, R.; Jouppila, P.; Hollmén, A

doi:10.1093/bja/67.6.678

Cited by 29 publications

(10 citation statements)

References 16 publications

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“…In our study neither single nor repeated epidural injections of adrenaline decreased uterine blood flow significantly. This corroborates the evidence that in normal pregnancies the use of epidural adrenaline causes no obvious problem [6, 7]. However, with an impaired fetal blood supply the use of local anaesthesia in combination wth adrenaline may be of concern.…”

Section: Introductionsupporting

confidence: 87%

Haemodynamic effects of repeated epidural test-doses of adrenaline in the chronic maternal-fetal sheep preparation

et al. 1998

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A randomized crossover study was designed using the chronically instrumented pregnant sheep preparation to study the possible effects of epidural injection of adrenaline as a single compound on the circulation of mother and fetus. Three consecutive identical doses of adrenaline were administered epidurally with a 30 min interval between treatments. In a randomized crossover fashion two dosages (10 and 15 micrograms) were tested on different days. The day after the last epidural experiment the same doses of adrenaline were given intravenously (i.v.). Between the two i.v. doses a 30 min interval was allowed for values to return to baseline. Twenty-seven experiments were performed in eight ewes. Epidural administration of adrenaline did not affect maternal mean arterial pressure, maternal heart rate, uterine blood flow, fetal mean arterial pressure, fetal heat rate, or maternal and fetal blood gases and acid-base status. After i.v. administration of adrenaline the uterine blood flow decreased in a dose-dependent fashion, but the other haemodynamic variables were not affected. In conclusion, this study indicates that consecutive epidural injections of adrenaline have no significant effect on maternal and fetal haemodynamic responses, uterine blood flow, blood gases and acid-base status in the gravid ewe. However, an i.v. injection of 10 or 15 micrograms adrenaline decreases the uterine blood flow and could compromise the fetus.

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Section: Introductionsupporting

confidence: 87%

Haemodynamic effects of repeated epidural test-doses of adrenaline in the chronic maternal-fetal sheep preparation

et al. 1998

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“…It will also increase motor blockade [26,36]. Uterine vasoconstriction is a risk of doses over 100 mg, therefore epinephrine is not used for continuous infusion techniques although it is useful for anaesthetic epidural block, for Caesarean section with bupivacaine and lidocaine [36,39].…”

Section: Adjuvant Drugsmentioning

confidence: 99%

Epidural analgesia-anaesthesia in obstetrics

Gomar

Fernández

2000

European Journal of Anaesthesiology

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Epidural analgesia is the most effective and innocuous technique for obstetrics. Pain relief is its main indication but maternal diseases that might be decompensated by labour and delivery are also accepted indications. Low doses of long-acting local anaesthetics alone or in combination with low doses of fentanyl or sufentanil provide good quality analgesia and are safe for mother and fetus. Test doses in parturients lack suf®cient speci®city and sensitivity for detecting inadvertent intravascular injection, and subarachnoid migration of the catheter is possible at any time during the procedure. Therefore, every injection must be considered as a test dose and only fractionated injections must be made. Epidural block to T10 is needed for labour and to level T4 for Caesarean section. Maintenance of the block with a continuous infusion, or patient-controlled epidural analgesia with a background continuous infusion, provides more stable analgesia than by intermittent injection. Technical dif®culties, dural tap, bloody tap, hypotension and insuf®cient block are most frequent complications of epidural block in obstetrics. Excessive motor block prolongs the second stage of labour and increases the frequency for instrumental delivery and is therefore considered a complication

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“…Our results using a continuous infusion of epinephrine are in agreement with the animal study in which the intravenous infusion of epinephrine (100 µg/h) on the pregnant ewe did not alter the uterine blood flow. 26 Alahuhta et al 32,33 also showed that the epinephrine did not affect the uteroplacental and fetal circulation in uncomplicated, singleton pregnancies unless the pregnancy was complicated with hypertension and chronic fetal asphyxia.…”

Section: Discussionmentioning

confidence: 98%

“…[23][24][25][26][27][28][29][30][31][32] Scientific concern is focused on whether the ␣-adrenergic effects of systemically absorbed epinephrine decrease uterine blood flow. In animal studies, a small dose of epidural 23 or intravenous 24,25 epinephrine produced a decrease in uterine blood flow.…”

Section: Discussionmentioning

confidence: 99%