Epinephrine is not a useful addition to intrathecal fentanyl or fentanyl-bupivacaine for labor analgesia

Goodman, Stephanie R.; Kim-Lo, Susan H.; Ciliberto, C F; Ridley, Diane M.; Smiley, Richard M.

doi:10.1097/00115550-200207000-00007

Cited by 7 publications

(8 citation statements)

References 16 publications

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“…Fentanyl, a lipophilic opioid in small doses added to local anaesthetics during sub arachnoid block produces a more rapid onset, surgical block of better quality (than local anaesthetics alone) and leads to more rapid recovery of motor function which then allows a quicker discharge post-surgery. [3,4,5,6,7,8] Choi et al reported that the combination of 8 mg Bupivacaine and 10 mcg Fentanyl is as efficient as 12 mg of hyperbaric Bupivacaine. [9] Incidence of bradycardia was comparable with study by Gulen Guler et al (n=30), in their study showed an incidence of bradycardia of 6.67% (2 cases) in LF group and 30% (9 cases) in BF group.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Spinal Anaesthesia With Levobupivacaine and Hyperbaric Bupivacaine Combined With Fentanyl in Caesarean Section

Kalepalli¹

2016

jebmh

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BACKGROUND Recent trends in obstetric anaesthesia show increased popularity of regional anaesthesia among obstetric anaesthetists. General anaesthesia in caesarean section is associated with high morbidity and mortality rate when compared with regional anaesthesia. Regional anaesthesia has its own demerits which are primarily related to excessively high spinal blocks and toxicity of local anaesthetics. Reduction in doses and improvement in technique to avoid high level blocks and increased awareness of toxicity of local anaesthetics have contributed to reduction in complications related to regional anaesthesia. The challenges presented by a parturient requiring anaesthesia or analgesia, or both, make the role of obstetric anaesthesiologist both challenging and rewarding. Spinal anesthesia is a popular technique for caesarean delivery. Hyperbaric Bupivacaine in 8% glucose is often used. Plain or glucose-free, Bupivacaine has been frequently referred to as "Isobaric" in the literature, even after Blomqvist and Nilsson demonstrated its hypobaricity. More recently, several studies have confirmed that plain Bupivacaine is indeed hypobaric in comparison with human CSF. Although hyperbaric local anesthetic solutions have a remarkable record of safety, their use is not totally without risk. To prevent unilateral or saddle blocks, patients should move from the lateral or sitting position rapidly to supine position. Hyperbaric solutions may cause sudden cardiac arrest after spinal anesthesia because of the extension of the sympathetic block. The use of truly isobaric solutions may prove less sensitive to position issues. Hyperbaric solutions may cause hypotension or bradycardia after mobilization. Isobaric solutions are favored with respect to their less sensitivity to postural changes. MATERIALS AND METHODS 60 full term parturients of ASA Grade 1 and 2 posted for elective caesarean section under spinal anaesthesia were divided in to two groups. GROUP LF (n = 30)-Received 1.8 ml (9 mg) Levobupivacaine 0.5% + Fentanyl 10 mcg (0.2 ml). GROUP BF (n = 30)-Received 1.8 ml (9 mg) hyperbaric Bupivacaine 0.5% + Fentanyl 10 mcg (0.2 ml). The parameters measured in the two groups included haemodynamic measurements (Pulse rate, systolic blood pressure, diastolic blood pressure), respiratory parameters (Respiratory rate, oxygen saturation) characteristics of sensory block, characteristics of motor block, intra operative and post-operative complications like nausea, vomiting, shivering, visceral pain, sedation. In the neonate, Apgar score was measured to assess any effects of drugs the neonate. RESULTS Hypotension and bradycardia was more in hyperbaric Bupivacaine group (BF). Time for Onset of sensory block and maximum dermatome level reached were similar in both groups. Time for maximum sensory level reached, two segment regression time, T12 regression time and time for first analgesic requirement were early in LF group. Onset of motor block was delayed in LF group. Maximum degree of motor block was same in both groups (Bromage 3). Co...

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Section: Discussionmentioning

confidence: 99%

A Comparison of Spinal Anaesthesia With Levobupivacaine and Hyperbaric Bupivacaine Combined With Fentanyl in Caesarean Section

Kalepalli¹

2016

jebmh

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“…Unfortunately, epinephrine also induces an increased incidence of maternal motor deficit especially when administered epidurally or intrathecally (212,213). Minute doses (2.25 µg) of spinal epinephrine were not associated with more motor block.…”

Section: Epinephrinementioning

confidence: 93%

“…Minute doses (2.25 µg) of spinal epinephrine were not associated with more motor block. Epidural epinephrine might also prolong labour duration by ß-agonist effects, especially when higher doses are infused in the epidural space (212)(213)(214)(215)(216). Furthermore adding epinephrine to pharmacist pre-prepared solutions complicates storage and significantly increases the price of handling and preparation.…”

Section: Epinephrinementioning

confidence: 99%

Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection

Velde

2009

Revista Española de Anestesiología y Reanimación

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Most authors would agree that central neuraxial analgesia is the best form to manage labor pain. When neuraxial analgesia is administered to the parturient in labor, different management choices must be made by theanesthetist: how will we initiate analgesia, how will analgesia be maintained, which local anesthetic will we use for neuraxial analgesia and which adjuvant drugs will we combine? The present manuscript tries to review the literature to answer these questions. INITIATION OF NEURAXIAL ANALGESIAA lmost two decades have passed since French and American trials evaluated the use of spinal opioids during labor and since European randomized trials compared conventional epidural analgesia with combined spinal epidural (CSE) analgesia (1-3). CSE analgesia has gained worldwide acceptance and is becoming increasingly popular as the method of choice for labor pain relief (4-9). Obstetric anesthetists are divided when questioned on the place of CSE in labor analgesia. Whilst some authors feel it should be the technique of choice, others reserve CSE for certain indications (10-15). Recently, Simmons et al. published a Cochrane review concluding that CSE offers little benefit as compared to conventional epidural analgesia (16). However, the authors of this meta-analysis did acknowledge that CSE produced faster analgesia, resulted in less need for rescue analgesia and was associated with less urinary retention. Apart from a slight increase in the incidence of pruritus, these beneficial effects were not associated with more complications. The three demonstrated benefits of CSE are sufficient to promotes it's use if the side-effect profile remains unaltered. Furthermore it must be stressed that this Cochrane review can be criticized. Firstly, a number of well performed studies were excluded from analysis because of uncertain reasons. Inclusion of these well performed studies into the analysis might have affected the overall conclusions. Secondly, a number of outcomes were not considered in the analysis such as one-sided analgesia, epidural catheter reliability, anesthetist intervention rate, local anesthetic consumption and the occurrence of fetal heart abnormalities. Finally, very different types of CSE were used in the various studies. They were all considered to be a generic procedure and analyzed combined.Arguably the most obvious advantage of the CSE technique is the rapid and spectacular onset of effective analgesia with minute concentrations of local anesthetics with or without adjuvant drugs (16). Consistently, effective labor analgesia is accomplished within 4-6 minutes

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“…Six trials (371 patients) tested epinephrine added to intrathecal LAs for labor analgesia using the CSE technique. 24,41,42,46,63,78 LAs were bupivacaine (5 trials) and ropivacaine (1). Doses of epinephrine ranged from 2.25 to 200 µg.…”

Section: Intrathecal Epinephrinementioning

confidence: 99%

Benefit and Harm of Adding Epinephrine to a Local Anesthetic for Neuraxial and Locoregional Anesthesia: A Meta-analysis of Randomized Controlled Trials With Trial Sequential Analyses

Tschopp

Tramèr

Schneider

et al. 2018

Anesthesia &Amp; Analgesia

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Epinephrine is not a useful addition to intrathecal fentanyl or fentanyl-bupivacaine for labor analgesia

Cited by 7 publications

References 16 publications

A Comparison of Spinal Anaesthesia With Levobupivacaine and Hyperbaric Bupivacaine Combined With Fentanyl in Caesarean Section

A Comparison of Spinal Anaesthesia With Levobupivacaine and Hyperbaric Bupivacaine Combined With Fentanyl in Caesarean Section

Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection

Benefit and Harm of Adding Epinephrine to a Local Anesthetic for Neuraxial and Locoregional Anesthesia: A Meta-analysis of Randomized Controlled Trials With Trial Sequential Analyses

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