The Effect of Adding Subarachnoid Epinephrine to Hyperbaric Bupivacaine and Morphine for Repeat Cesarean Delivery: A Double-blind Prospective Randomized Control Trial

Abstract

(Anesth Analg. 2018;127:171–178) A major limitation of spinal anesthesia is that the duration of the anesthetic may not be adequate in the event of a prolonged surgery. Bupivacaine without an adjuvant provides ∼120 minutes of surgical anesthesia. Epinephrine added to lidocaine or tetracaine can increase the block’s duration as much as 2-fold. However, less is known about the prolongation of spinal block when epinephrine is added to bupivacaine. In the present study, the authors evaluated whether the addition of subarachnoid epinephrine to bupivacaine and morphine would prolong the duration of surgical anesthesia for repeat cesarean delivery as measured by the time to T-10 regression or activation of the epidural for patient comfort.

Risk Factors Associated with Somato-Visceral Pain Investigation, in Scheduled Cesarean Section under Epidural Anesthesia with Lidocaine 2% and Adrenaline

“…Our findings are very close to Sharawi N, et al study's findings in lidocaine-use with 3 additives [21], in purpose to achieve the highest quality of surgical analgesia, but better compared to 3% chloroprocaine results [21], and other many previous studies, with different LAs, additives, different anesthesia techniques and positions [13,20,[22][23][24]. It is actually known that epidural adrenaline has antinociceptive properties and enhances analgesia duration when co-administered with Las [25][26]. In addition, Aliza Olapour, et al recently found that sensory and motor block with lidocaine were superior to the ropicaine's, and added adrenaline exerts important role [25][26][27].…”

Intrathecal catheter use after accidental dural puncture in obstetric patients: literature review and clinical management recommendations

“…Details of reported studies are provided in online Supporting Information Table S1. Two studies from the same institution described the administration of low‐dose epinephrine in their intrathecal catheter solutions [18, 19]; the addition of spinal epinephrine has been observed to prolong sensory block, increase analgesic efficacy and augment motor block [32].…”

“…the addition of spinal epinephrine has been observed to prolong sensory block, increase analgesic efficacy and augment motor block [32].…”

Incidence of Hypotension and Associated-risk Factors in Epidural Anesthesia With 2% Lidocaine and Epinephrine During Elective Cesarean Section, Efficacy and Safety Assessment

“…E. Bjornestad and coworkers [29] found 20% and 30% of visceral pain in their study with epidural lidocaine and epidural 2-chloroprocaine respectively, while Yicheng Yang and colleagues [38] found an intraoperative pain incidence ranged at 70% and 47.5% respectively in epidural ropivacaine-morphine and epidural ropivacaine-morphinedexmedetomidine. It is actually known that epinephrine has some properties of antinociceptive and enhances the duration of analgesia used together with LAs [39,40] . Furthermore, recent researches by Aliza Olapour et al [41] said that lidocaine's sensory and motor block were superior to the Ropivacaine's, and epinephrine was found to exert an essential role [39] .…”

“…It is actually known that epinephrine has some properties of antinociceptive and enhances the duration of analgesia used together with LAs [39,40] . Furthermore, recent researches by Aliza Olapour et al [41] said that lidocaine's sensory and motor block were superior to the Ropivacaine's, and epinephrine was found to exert an essential role [39] . Moreover, Meechan and co-authors [42] let know that anesthesia effects of ropivacaine in their study were inferior to those with lidocaine-epinephrine.…”