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:10.1053/rapm.2002.33283

Cited by 12 publications

(5 citation statements)

References 25 publications

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“…Although the mechanisms of epinephrine-induced nausea and vomiting have not been clearly elucidated, it is likely through the central effects of α-adrenergic receptor stimulation. [ 7 , 25 , 26 ] In this study, the Koivuranta PONV risk factor scores between the EPI and NS groups were relatively consistent, and there was no significant difference in the PONV event between the 2 groups, and the hemodynamic parameters after surgery were not significantly different between the 2 groups. [ 17 , 18 ] Therefore, it is thought that the level of circulatory epinephrine after surgery is unlikely to affect the incidence of nausea and vomiting.…”

Section: Discussionmentioning

confidence: 63%

Hemodynamic protective effects of epinephrine containing saline irrigation in biportal endoscopic lumbar surgery

Ko¹,

Cho²,

Jang³

et al. 2022

Medicine

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During endoscopic orthopedic surgery, epinephrine mixed with irrigation saline is frequently used to improve visualization. By monitoring hemodynamic parameters throughout the procedure, we intended to discover the hemodynamic effect of epinephrine between the normal saline irrigation fluid without epinephrine group (NS) and normal saline irrigation fluid with epinephrine group (EPI).Patients who underwent 1-level lumbar decompression or discectomy surgery without fusion between August 2019 and July 2020 were reviewed retrospectively. The hemodynamic parameters were compared between the NS group and EPI group. As a second endpoint, the incidence of hypotension and hypertension events, expected blood loss, postoperative nausea and vomiting and postoperative epidural hematoma were compared between the 2 groups.The 2 groups were homogeneous in terms of age, sex, weight, height, body mass index (BMI), ASA physical status (ASA PS), and diagnosis. The incidence of hypotension events (67.2 % in the NS group, 45.7 % in the EPI group, P =.015) and severe hypotension events (51.7 % in the NS group, 28.6 % in the EPI group, P = .015) were less frequent in the EPI group. Only epinephrine had a significant protective effect through a multivariable analysis (P = .027, OR = 2.361) and in severe hypotension events, only epinephrine had a significant protective effect through a multivariable analysis (P = .011, OR = 2.818), and EBL was the risk factor through a multivariable analysis (P = .016, OR = 1.002)We believe that the addition of epinephrine to irrigation saline has hemodynamic protective effects in patients who underwent endoscopic lumbar surgery.

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Section: Discussionmentioning

confidence: 63%

Hemodynamic protective effects of epinephrine containing saline irrigation in biportal endoscopic lumbar surgery

Ko¹,

Cho²,

Jang³

et al. 2022

Medicine

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“…For women with a prior cesarean delivery, the repeat cesarean rate has been reported as greater than 90% [ 1 , 2 ]. Intrathecal epinephrine is an adjuvant to local anesthetics and opioids to potentiate analgesia via α2-adrenergic receptor stimulation, while its vasoconstrictive properties, primarily via α1-adrenergic receptor activation, increase block duration [ 3 , 4 ]. Two meta-analyses demonstrated the prolongation of sensory and motor blockade by adding intrathecal epinephrine to spinal anesthesia [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of Adding Intrathecal Epinephrine to Spinal Anesthesia on Anesthesia-Related Cesarean Delivery Outcomes: Should We Reconsider Its Use?

Rambhia,

DeLeon,

Bauchat

et al. 2023

Cureus

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Background: Intrathecal epinephrine is used to increase the duration of spinal anesthesia for amenable surgical procedures anticipated to require additional time; however, in the ambulatory setting, it is associated with a prolonged time to post-anesthesia care unit (PACU) discharge. The current study's authors hypothesized that adding intrathecal epinephrine to spinal anesthesia for cesarean delivery would be associated with a dose-dependent prolonged post-anesthesia unit length of stay. Methods: A single-center, retrospective study of patients undergoing repeat cesarean delivery under spinal anesthesia from 2011 to 2015 was conducted. Patients received spinal bupivacaine 12 mg, morphine 150 mcg, and fentanyl 15 mcg with no-epinephrine, 100 mcg, or 200 mcg of epinephrine. The primary outcome was recovery room length of stay. Secondary outcomes were surgical duration, intraoperative vasopressor use, perioperative opioids, and antiemetic use. Results: Data were analyzed for 1,362 patients. Median recovery room stay was 123 min (interquartile range, 100 to 150) and was not different among groups. More women receiving epinephrine 200 mcg had ≥2 prior cesarean deliveries compared with no-epinephrine or 100 mcg. No significant differences in surgical duration or intraoperative opioids were identified among the groups. Median intraoperative vasopressor use was increased by 225 mcg of phenylephrine equivalents (99% CI, 25 mcg to 430 mcg) in the 100 mcg group and 250 mcg of phenylephrine equivalents in the 200 mcg group (99% CI, 75 mcg to 500 mcg) compared to no-epinephrine ( P <0.001). Recovery room antiemetic and opioid analgesic administration were not different among groups. Conclusions: Based on the results of this study, the addition of intrathecal epinephrine for women undergoing cesarean delivery increases intraoperative vasopressor use but does not prolong PACU length of stay, reduce intraoperative opioids, or increase antiemetic requirements postoperatively. The current study also demonstrated that surgical duration times were not different among the no-epinephrine, 100 mcg, and 200 mcg epinephrine groups.

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“…Regional analgesia involves spinal, epidural, and combined spinal-epidural methods that apply to induce analgesia in labor ( 7 , 8 ). In spinal analgesia, single-dose injection of opioids alone or in combination with a lower dose of anesthetics to the subarachnoid space causes rapid and effective analgesia during labor ( 8 , 9 ). Hypotension is the most common complication of spinal anesthesia and analgesia ( 10 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Intrathecal Injection of Fentanyl and Sufentanil on the Onset, Duration, and Quality of Analgesia in Labor: A Randomized, Double-Blind Clinical Trial

et al. 2020

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Background: Labor pain is a severe pain, and intrathecal opioid injection is one of the analgesia methods to reduce it. Objectives: We assessed the effects of intrathecal Fentanyl and Sufentanil on the onset, duration, and quality of analgesia for labor analgesia. Methods: In this double-blind, randomized clinical trial, 54 healthy nulliparous women 18 - 45 years in the active phase of labor who were requesting labor analgesia were enrolled in two groups fentanyl (F) and sufentanil (S). Patients received 75 µg fentanyl or 7.5 µg sufentanil intrathecally in the fentanyl group (n = 27) and the sufentanil group (n = 27), respectively. Pain relief, onset, duration of analgesia, hemodynamic parameters, patients' satisfaction, and neonatal Apgar score were assessed in this study. Data were analyzed by using SPSS16. Results: There were no significant differences between the groups in terms of demographic and hemodynamic parameters. The onset time of analgesia was 5.6 ± 4.3 and 3.6 ± 2.1 minutes, in the sufentanil and fentanyl groups, respectively (P = 0.037). The duration of analgesia was higher in patients who received sufentanil than those who received fentanyl (113 ± 45 vs. 103 ± 22 minutes (P = 0.629)). The pain score in the Fentanyl group was significantly lower at 5, 10, and 15 minutes after spinal analgesia (P < 0.05). The sedation score at 1 and 5 minutes was significantly higher in the fentanyl group than the sufentanil group (P < 0.05). The frequency and severity of pruritus and satisfaction rate in the fentanyl group were significantly higher than the sufentanil group. Conclusions: Intrathecal fentanyl and sufentanil have a similar analgesic effect on labor. Fentanyl is associated with a faster onset of analgesia and more satisfaction, while sufentanil has longer analgesia.

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

Cited by 12 publications

References 25 publications

Hemodynamic protective effects of epinephrine containing saline irrigation in biportal endoscopic lumbar surgery

Hemodynamic protective effects of epinephrine containing saline irrigation in biportal endoscopic lumbar surgery

Effects of Adding Intrathecal Epinephrine to Spinal Anesthesia on Anesthesia-Related Cesarean Delivery Outcomes: Should We Reconsider Its Use?

Comparison of Intrathecal Injection of Fentanyl and Sufentanil on the Onset, Duration, and Quality of Analgesia in Labor: A Randomized, Double-Blind Clinical Trial

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