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Anesth Analg 2002 Oct;95(4):1127
Baskent University School of Medicine, Department of Anesthesiology, Ankara, Turkey.
[Medline record in process]
PMID: 12351321, UI: 22238230
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Anesth Analg 2002 Oct;95(4):1119
Department of Anesthesiology, Memorial Sloan-Kettering Cancer Center and, Weill Medical College of Cornell University, New York, NY. HCI International Medicine Centre, Clydebank, Scotland.
PMID: 12351309, UI: 22238218
Anesth Analg 2002 Oct;95(4):1115-8
The Children's Hospital, University of Colorado School of Medicine, Denver.
PMID: 12351307, UI: 22238216
Anesth Analg 2002 Oct;95(4):1024-30
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
Efforts to reduce controlled-substance abuse by anesthesiologists have focused on education and tighter regulation of controlled substances. However, the efficacy of these approaches remains to be determined. Our hypotheses were that the reported incidence of controlled-substance abuse is unchanged from previous reports and that the control and accounting process involved in distribution of operating room drugs has tightened. We focused our survey on anesthesiology programs at American academic medical centers. Surveys were sent to the department chairs of the 133 US anesthesiology training programs accredited at the end of 1997. There was a response rate of 93%. The incidence of known drug abuse was 1.0% among faculty members and 1.6% among residents. Fentanyl was the controlled substance most often abused. The number of hours of formal education regarding drug abuse had increased in 47% of programs. Sixty-three percent of programs surveyed had tightened their methods for dispensing, disposing of, or accounting for controlled substances. The majority of programs (80%) compared the amount of controlled substances dispensed against individual provider usage, whereas only 8% used random urine testing. Sixty-one percent of departmental chairs indicated that they would approve of random urine screens of anesthesia providers. IMPLICATIONS: This survey indicates that the frequency of controlled substance abuse among anesthesiologists has changed little in the past few years, despite an increase in the control and accounting procedures for controlled substances as well as increased mandatory education.
PMID: 12351288, UI: 22238197
Anesth Analg 2002 Oct;95(4):1019-23
Department of Anesthesiology, University of Texas Health Science Center, Houston.
PMID: 12351287, UI: 22238196
Anesth Analg 2002 Oct;95(4):1012-8
Department of Anesthesiology, Bispebjerg University Hospital, Copenhagen, Denmark.
IMPLICATIONS: This article illustrates the basic principles of evidence-based medicine and the work within the Cochrane Collaboration and the Cochrane Anesthesia Review Group. It describes how important randomized controlled trials and systematic reviews are in providing the best evidence to answer clinically relevant questions.
PMID: 12351286, UI: 22238195
Anesth Analg 2002 Oct;95(4):992-6
GRETAC, Laboratoire de Biologie Cellulaire, and Laboratoire de Pharmacologie Galenique et de Biopharmacie, Universite Rennes I.
We studied the inhibition of peroxidation by local anesthetics in an inflammatory animal model. Inflammatory lipid peroxidation was assessed by the thiobarbituric assay in plasma from rats injected or not injected with carrageenan (Carra) and killed 1, 2, 4, 6, 12, and 24 h thereafter. Thiobarbituric acid reactive substances (TBARS) values in inflammatory animals were maximal 6 h after Carra administration. This result, in accordance with the evolution of paw edema width during time, supports that TBARS reflect the intensity of inflammation. Local anesthetics (bupivacaine, lidocaine, ropivacaine, or bupivacaine-loaded microspheres) or amitriptyline were injected in clinically relevant concentrations as a sciatic nerve block or intraperitoneally in inflamed animals. Ropivacaine did not exhibit any protective effect on Carra-induced lipid peroxidation in rats. With all the other drugs administered as a sciatic nerve block, the maximal TBARS increase was not observed at 6 h. Our conclusion is that bupivacaine (plain or encapsulated), lidocaine, and amitriptyline in clinically relevant concentrations administered via the sciatic nerve showed antioxidant properties toward lipid peroxidation induced by Carra inflammation. Intraperitoneal injection of those drugs gave the same effect as nerve block; this result suggests that their mechanism of action is not strictly limited to the nerve. IMPLICATIONS. We investigated the antioxidant effects of local anesthetics and amitriptyline in an inflammatory rat model. Amitriptyline exhibits antioxidant properties per se, whereas lidocaine and bupivacaine (plain or encapsulated) seem to inhibit the peroxidation process. This may have future application in limiting toxic oxygen metabolite production during the inflammatory process.
PMID: 12351282, UI: 22238191
Anesth Analg 2002 Oct;95(4):952-5
Department of Anesthesiology, University of Hirosaki School of Medicine, Japan.
Tumor necrosis factor-alpha (TNFalpha) is a crucial neuromodulator in the brain. TNFalpha is involved in many physiological events including pain response and sleep. However, the interactions between TNFalpha and anesthetics have not been elucidated yet. In the present study, we investigated the effects of four intracerebroventricular (ICV) doses (1, 10, and 100 pg, and 1 ng) and two intraperitoneal (IP) doses (10 and 100 ng) of TNFalpha on anesthesia time of ketamine (100 mg/kg IP) and propofol (80 mg/kg IP) in rats. All ICV doses of TNFalpha reduced anesthesia time of ketamine and propofol compared with the saline ICV group (ketamine control group, 45.4 +/- 6.5 min; propofol control group, 43.5 +/- 11.0 min). The maximum effect was obtained after the ICV injection of 10 pg of TNFalpha (76% and 54% of ketamine and propofol control groups, respectively). Anesthesia time of ketamine or propofol was also decreased by IP injection of TNFalpha in a dose-dependent manner. Injection of 100 ng of TNFalpha IP reduced anesthesia time of ketamine and propofol by 67% and 64% of each control group, respectively. These data show that TNFalpha can modulate the anesthesia time of IV anesthetics, suggesting that anesthetic requirements might be altered in the presence of cerebral or systemic inflammation. IMPLICATIONS: Tumor necrosis factor alpha (TNFalpha) regulates many physiological events in the brain. We investigated the effects of TNFalpha on anesthesia time in rats. Both central and peripheral administration of TNFalpha decreased anesthesia time induced by ketamine and propofol.
PMID: 12351275, UI: 22238184
Anesth Analg 2002 Oct;95(4):915-9
Hopitaux Universitaires de Strasbourg.
There is growing evidence that propofol acts on affective and reward processes. We designed this study to assess the effect of propofol on the concentration of dopamine in the nucleus accumbens, a main component of the mesolimbic system. The concentration of dopamine in the nucleus accumbens was assessed by using in vivo brain microdialysis in freely moving rats. A microdialysis probe was placed within guide cannulae previously placed during stereotaxic surgery. Fluid was perfused through the probe, and samples were collected every 20 min for measuring concentrations by high-pressure liquid chromatography. All rats served as their own controls and were randomized to four different doses of propofol, injected intraperitoneally: 0, 9, 60, or 100 mg/kg, according to a within design. Compared with the baseline value, dopamine concentration was decreased at the smallest dose of 9 mg/kg, whereas concentration was largely increased at the subanesthetic (60 mg/kg) and anesthetic (100 mg/kg) doses. This increase was of the same magnitude (+90%) for subanesthetic and anesthetic doses but was more prolonged at the anesthetic dose. Data show that only subanesthetic and anesthetic doses of propofol increase the concentration of dopamine in the nucleus accumbens, as previously described with drugs of potential abuse. IMPLICATIONS: Depending on the dose, propofol either increased or decreased the concentration of dopamine in the nucleus accumbens, as assessed during microdialysis in freely moving rats. Only large doses which display a pharmacological profile, such as propofol, may show promise.
PMID: 12351267, UI: 22238176
Anesth Analg 2002 Oct;95(4):900-6
Departments of Anesthesiology, Physiology, and Pharmacology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu.
Several lines of evidence suggest that nicotinic acetylcholine receptors (nAChRs) are a target of general anesthetics. Alphaxalone (5alpha-pregnan-3alpha-ol-11, 20-dion) is a neurosteroid, which was used clinically for anesthesia, but its effects on the function of nAChRs have not been well investigated. We examined the effects of alphaxalone on nAChRs in cultured bovine adrenal chromaffin cells. We studied the effects of alphaxalone on nicotine-induced increases in the cytosolic Ca(2+) concentration ([Ca(2+)](i)) and on membrane currents using Ca(2+)-imaging and whole-cell patch-clamp techniques, respectively, in these cells. We also examined the effects of alphaxalone on gamma-aminobutyric acid A receptors in the same cells and compared them with the effects on nAChRs. Alphaxalone (0.1-100 micro M) inhibited nicotine-induced [Ca(2+)](i) increases in a concentration-dependent manner. Alphaxalone inhibited high K(+)-induced [Ca(2+)](i) increases, but the inhibition was observed only at 100 micro M. In voltage-clamp experiments using negative holding potentials, alphaxalone (0.1-100 micro M) itself induced inward currents, which were abolished by the gamma-aminobutyric acid A receptor antagonist picrotoxin. Alphaxalone also inhibited nicotine-induced inward currents, and the inhibition was unaffected by picrotoxin. We conclude that alphaxalone, at anesthetic concentrations, inhibits nAChRs in adrenal chromaffin cells. Alphaxalone may affect the sympathetic and other nervous systems via inhibition of nAChRs. IMPLICATIONS: Alphaxalone inhibits the function of nAChRs at clinically relevant concentrations in adrenal chromaffin cells. Thus, the present findings may provide some information for understanding the anesthetic mechanism of alphaxalone.
PMID: 12351265, UI: 22238174
Anesth Analg 2002 Oct;95(4):893-9
Departments of Anesthesiology and Pharmacology, Weill Medical College of Cornell University, New York, New York.
The effects of general anesthetics on neurotransmitter uptake by plasma membrane transporters are controversial. We analyzed the effects of representative volatile and IV general anesthetics on recombinant transporters for norepinephrine (human NET), dopamine (rat DAT), or gamma-aminobutyric acid (rat GAT-1) stably expressed in a porcine kidney cell line (LLC-PK(1)). This approach avoids complicating factors associated with neuronal preparations, such as the involvement of multiple transporters and the indirect effects of membrane potential. At clinical concentrations, human NET was inhibited only by halothane (50% inhibitory concentration [IC(50)] = 0.54 mM), rat DAT was sensitive to both halothane and isoflurane (IC(50) = 0.60 and 0.64 mM, respectively), and rat GAT-1 was insensitive to both volatile anesthetics. Human NET was inhibited in a dose-dependent fashion by propofol (IC(50) = 41 micro M), ketamine (IC(50) = 150 micro M), and etomidate (IC(50) > 200 micro M), but not by pentobarbital. Only propofol inhibited NET at a clinically relevant concentration (5 micro M). Rat DAT was inhibited in a dose-dependent fashion by propofol (IC(50) = 120 micro M), etomidate (IC(50) = 100 micro M), and ketamine (IC(50) = 210 micro M), but not by pentobarbital. None of these anesthetics was predicted to inhibit DAT at concentrations that produce anesthesia. Propofol inhibited rat GAT-1, but only at the largest concentration tested. General anesthetics have drug- and subtype-selective actions on neurotransmitter transporters. We conclude that effects on catecholamine, but not gamma-aminobutyric acid, transporters may contribute to secondary synaptic actions of certain anesthetics but are unlikely to be essential to their anesthetic properties. IMPLICATIONS: Previous studies have implicated neurotransmitter transporters as targets for general anesthetic effects on synaptic transmission. Recombinant transporters for norepinephrine and dopamine were sensitive to certain volatile and IV anesthetics, whereas gamma-aminobutyric acid transporters were insensitive. These anesthetic- and neurotransmitter-specific effects may underlie some of the secondary effects of general anesthetics.
PMID: 12351264, UI: 22238173
Anesth Analg 2002 Oct;95(4):879-88
Department of Anesthesia, Foothills Medical Center, Calgary, Alberta, Canada.
PMID: 12351262, UI: 22238171
Anesth Analg 2002 Oct;95(4):791-7
Departments of Anesthesiology, Intensive Care Medicine and Pain Control and Thoracic and Cardiovascular Surgery, J. W. Goethe University Hospital Center, Frankfurt, Germany.
Recent developments in coronary artery bypass graft surgery (CABG) without cardiopulmonary bypass made the sole use of high thoracic epidural anesthesia (TEA) in conscious patients feasible. Previously, TEA has been reported only for single-vessel CABG via lateral thoracotomy. We investigated the feasibility and complications of sole TEA in 20 patients undergoing beating-heart arterial revascularization via partial lower sternotomy for single-vessel disease (minimally invasive direct coronary artery bypass grafting [MIDCAB] technique; n = 10) or complete median sternotomy for multivessel disease (off-pump coronary artery bypass grafting [OPCAB] technique; n = 10). An epidural catheter was inserted at the T1-2 or T2-3 interspace. An epidural infusion of ropivacaine 0.5% and sufentanil 1.66 micro g/mL was started to establish anesthetic levels at C5-6 for OPCAB and at T1-2 for MIDCAB. Nine OPCAB and eight MIDCAB procedures were completed while patients were awake and spontaneously breathing during the entire procedure. Because of surgical pneumothorax (OPCAB), insufficient anesthesia, or phrenic nerve palsy (both MIDCAB), three patients required intraoperative conversion to general anesthesia. The heart rate decreased significantly (P < 0.05) by 10%-15% in both groups during the procedure. Compared with baseline (B), mean arterial blood pressure (mm Hg) was decreased significantly only during coronary anastomosis (CA) (B(OPCAB), 95 +/- 11; CA(OPCAB), 68 +/- 9; B(MIDCAB), 86 +/- 10; CA(MIDCAB), 73 +/- 10; P not significant between groups). PaCO(2) increased from 42 +/- 2 mm Hg to 46 +/- 7 mm Hg (P < 0.05) throughout the perioperative course during OPCAB, whereas it remained almost unaltered during MIDCAB procedures. All patients rated TEA as "good" or "excellent." In conclusion, we demonstrated that the sole use of TEA for MIDCAB and OPCAB procedures was feasible and provided a high degree of patient satisfaction in our small and highly selected cohorts. IMPLICATIONS. The sole use of high thoracic epidural anesthesia was studied in 20 patients who underwent beating-heart coronary artery bypass grafting using either median or partial lower sternotomy while awake.
PMID: 12351247, UI: 22238156
Anesthesiology 2002 Sep;97(3):761; discussion 762
Publication Types:
PMID: 12218561, UI: 22205791
Anesthesiology 2002 Sep;97(3):757; discussion 758
PMID: 12218557, UI: 22205787
Anesthesiology 2002 Sep;97(3):756-7; discussion 757
PMID: 12218556, UI: 22205786
Anesthesiology 2002 Sep;97(3):755-6; discussion 756
PMID: 12218555, UI: 22205785
Anesthesiology 2002 Sep;97(3):740-3
Berufsgenossenschaftliche Kliniken Bergmannsheil, Ruhr Universitat Bochum, Germany. christoph.maier@ruhr-uni-bochum.de
PMID: 12218545, UI: 22205775
Anesthesiology 2002 Sep;97(3):733-4
Abteilung fur Anasthesiologie und Intensivmedizin, Universitatsklinikum Essen, Germany. frank.herbstreit@uni-essen.de
PMID: 12218542, UI: 22205772
Anesthesiology 2002 Sep;97(3):574-7
Department of Anesthesia, Stanford University School of Medicine, California 94305, USA. edriley@Leland.stanford.edu
BACKGROUND: Prior experience with the combined spinal-epidural technique (CSE) for labor analgesia demonstrated a high (up to 14%) failure rate because of failure to obtain cerebrospinal fluid (CSF) or lack of response to appropriate doses of intrathecal sufentanil. The current study was designed to test whether a longer needle with a shorter side port (Gertie Marx needle; 127 mm long) would eliminate failures to obtain CSF compared with the needle we had used previously (Sprotte needle; 120 mm long). METHODS: Seventy-three parturients were randomly assigned to have a CSE performed with one of these two needles. After identifying the epidural space with an 18-gauge Touhy needle at the L2-L3 or L3-L4 interspace, the spinal needle was introduced through the Touhy needle until penetration of the dura was felt or until the needle was maximally inserted. If no CSF was obtained, the alternate needle was tried. After obtaining CSF, 10 microg sufentanil diluted in 1.8 ml saline was injected. Verbal pain scores (0-10) were obtained every 5 min for 30 min. RESULTS: Failure to obtain CSF occurred six times in the Sprotte group compared with none in the Gertie Marx group (P < 0.05). In all six failures in the Sprotte group, the Gertie Marx needle subsequently proved successful in obtaining CSF. There were no differences in pain scores between the groups. CONCLUSIONS: The extra length of the 127-mm Gertie Marx needle resulted in a higher success rate for obtaining CSF when used in the CSE technique. Side port design was not a factor influencing success in this clinical setting.
PMID: 12218522, UI: 22205752
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BMJ 2002 Sep 7;325(7363):548
PMID: 12218001, UI: 22205919
Br Dent J 2002 May 11;192(9):486; discussion 487
PMID: 12047118, UI: 22042045
Br Dent J 2002 May 11;192(9):486
PMID: 12047117, UI: 22042044
Can J Anaesth 2002 Aug-Sep;49(7):657-8
PMID: 12269293, UI: 22228707
Eur J Anaesthesiol 2002 Sep;19(9):687
PMID: 12243294, UI: 22228008
Eur J Anaesthesiol 2002 Sep;19(9):672-6
Gifu University School of Medicine, Department of Anesthesiology & Critical Care Medicine, Gifu City, Japan.
BACKGROUND AND OBJECTIVE: Although combined spinal and epidural anaesthesia is efficient and easy to perform, the technique can be a double-edged sword having the potential risk that an increased flux of drugs across the meninges through the hole made in it may lead to severe adverse effects. The aim was to compare the incidence of adverse events when an epidural injection of morphine was given after combined spinal and epidural anaesthesia or after epidural anaesthesia. METHODS: Fifteen patients had an epidural catheter inserted at the L2-3 interspace, and then a spinal block administered via the L3-4 interspace. Another 15 patients only had an epidural catheter inserted. After the onset of spinal or epidural anaesthesia had been confirmed, morphine 2 mg was injected into the epidural space, and a continuous epidural infusion of morphine was started. At the end of the operation and at 4, 8 and 12 h after the administration of epidural morphine and on the next day, the following variables were examined: blood pressure, heart rate, respiratory rate, arterial blood-gas analysis, visual analogue scale pain scores, nausea/vomiting scores, and pruritus scores. RESULTS: In the study population, the epidural injection of morphine was not associated with a significantly higher incidence of adverse events when given after spinal anaesthesia than after epidural anaesthesia. CONCLUSIONS: The adverse effects associated with epidural morphine given after spinal anaesthesia did not increase significantly when a 27-G Whitacre needle was used. Thus, the morphine flux through the meningeal hole into the cerebrospinal fluid was trivial.
PMID: 12243291, UI: 22228005
Eur J Anaesthesiol 2002 Sep;19(9):658-65
Medizinische Hochschule Hannover, Zentrum Anaesthesiologie, Germany. adams.ha@mh-hannover.de
BACKGROUND AND OBJECTIVE: To investigate the interactions of postoperative pain and endocrine stress response, three groups of 21 patients each with total knee arthroplasty were compared in a randomized, prospective design. For postoperative pain management, a three-in-one block, an epidural catheter analgesia or an intravenous patient-controlled analgesia was used. METHODS: After standardized balanced anaesthesia, the pain intensity was measured by a visual analogue scale (VAS). For detection of epinephrine, norepinephrine, antidiuretic hormone, adrenocorticotropic hormone and cortisol in the plasma, blood samples were taken at six time points before and up to 180 min after the start of pain therapy. In addition, systolic arterial pressure, heart rate, partial arterial oxygen saturation, nausea, vomiting and satisfaction of the patients were recorded. RESULTS: Within 15 min after the start of pain therapy, VAS in all groups was similarly reduced from >40 mm to a range <10 mm (P < 0.001). Initially, all endocrine stress variables exceeded the normal range. Epidural anaesthesia led to a significant decrease of epinephrine and norepinephrine concentrations, while an increase was observed in the group with patient-controlled analgesia, and the decrease in patients with the three-in-one block was less than in patients receiving epidural anaesthesia (P = 0.001). Differences in antidiuretic hormone, adrenocorticotropic hormone and cortisol were less pronounced. Systolic arterial pressure decreased significantly in all groups, particularly in patients with epidural anaesthesia. Partial arterial oxygen saturation and the incidence of nausea and vomiting were comparable. All patients were satisfied with the methods used. CONCLUSIONS: All methods of pain management led to sufficient analgesia, but they were not accompanied by an adequate reduction in endocrine stress response. Thus, postoperative pain is only a secondary stressor and sufficient analgesia with subjective well-being does not prove a stress-free state. With regard to the reduction of sympathoadrenergic stress response, epidural anaesthesia is superior to the three-in-one block and patient-controlled analgesia. Epidural anaesthesia is recommended particularly for high-risk patients with hypertension, coronary heart disease and diabetes mellitus. In these patients, the reduction of a 'hidden' endocrine stress response in addition to prevention of pain is of special interest.
PMID: 12243289, UI: 22228003
Eur J Anaesthesiol 2002 Sep;19(9):641-6
Tuebingen University Hospital, Department of Anaesthesiology and Intensive Care Unit, Germany. helene.haeberle@uni-tuebingen.de
BACKGROUND AND OBJECTIVE: Isoflurane is a chiral, volatile anaesthetic with low metabolic rate (0.17%) that is routinely administered in its racemic form. Knowledge about the distribution of the enantiomers in human beings may give some important information about the understanding of the mechanisms of volatile anaesthetics. METHODS: Blood samples were drawn immediately after tracheal extubation and daily up to 8 days postoperatively from patients undergoing general anaesthesia with isoflurane racemate. The enantiomer enrichment of isoflurane was determined by headspace gas chromatography-mass spectrometry. RESULTS: At all time points, there was a statistically significant accumulation of the S(+) enantiomer in blood, especially at days 2 (52.01%) and 7 (52.1%). Separate analysis of obese patients or in a small group of patients with co-existing lung disease did not show any difference to the total population. In addition, duration of anaesthesia did not influence the enantiomer concentrations. CONCLUSIONS: We suggest that a slower association and dissociation rate is responsible for the S(+) enrichment.
PMID: 12243286, UI: 22228000
Reg Anesth Pain Med 2002 Jul-Aug;27(4):447; discussion 447
PMID: 12132076, UI: 22127018
Reg Anesth Pain Med 2002 Jul-Aug;27(4):446; discussion 446-7
PMID: 12132074, UI: 22127016
Reg Anesth Pain Med 2002 Jul-Aug;27(4):444-5
PMID: 12132072, UI: 22127014
Reg Anesth Pain Med 2002 Jul-Aug;27(4):442-3; discussion 443-4
PMID: 12132070, UI: 22127012
Reg Anesth Pain Med 2002 Jul-Aug;27(4):439-41; discussion 441-2
PMID: 12132067, UI: 22127009
Reg Anesth Pain Med 2002 Jul-Aug;27(4):429-32
Department of Anesthesiology and Critical Care Medicine, Jichi Medical School, Tochigi, Japan. yhira@jichi.ac.jp
BACKGROUND AND OBJECTIVES: Leg manipulation has been postulated to affect spinal curvature and position of the cauda equina within the dural sac. However, no evidence of such mechanical effects has been shown in living subjects. We used magnetic resonance imaging to evaluate the mechanical effects of leg position on these 2 parameters. METHODS: Sagittal and axial magnetic resonance images of the lumbosacral vertebral canal were obtained in 5 healthy, female volunteers with the subject in the supine position with knees straight, knees slightly flexed, and knees fully flexed. RESULTS: In the straight leg position, physiologic lumbar lordosis was evident in all subjects on midline sagittal slices, whereas lumbar lordosis disappeared in the fully flexed leg position. On the axial slices the cauda equina moved ventrally within the dural sac in all subjects in the fully flexed leg position. In 1 of the 5 subjects the cauda equina moved ventrally and also separated completely into right and left parts. CONCLUSIONS: Our findings indicate that 2 potential factors, flattening of the lumbar lordosis and some added tension on the lumbosacral nerve roots, may contribute to postoperative back and leg aching after spinal anesthesia in the lithotomy position.
PMID: 12132065, UI: 22127007
Reg Anesth Pain Med 2002 Jul-Aug;27(4):374-9
Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. srg24@columbia.edu
BACKGROUND AND OBJECTIVES: Intrathecal fentanyl provides effective labor analgesia for a limited time with frequent side effects. We evaluated the effects of adding epinephrine to intrathecal fentanyl with and without bupivacaine. METHODS: Eighty healthy, term, nulliparous parturients with cervical dilation of 5 cm or less received combined spinal-epidural (CSE) analgesia. Subjects were randomized in a double-blind fashion to 1 of 4 intrathecal solutions containing fentanyl 35 microg with either saline (F); bupivacaine 2.5 mg + saline (FB); bupivacaine 2.5 mg + epinephrine 100 microg (FBE); or epinephrine 100 microg + saline (FE). Patients were evaluated for visual analog pain score, duration of spinal analgesia (time until patient request for additional analgesia), nausea/vomiting, pruritus, sensory and motor block, maternal blood pressure, and fetal heart rate (FHR). RESULTS: Intrathecal bupivacaine significantly prolonged fentanyl analgesia with or without epinephrine (P =.018), but epinephrine did not significantly prolong the duration of fentanyl alone or with bupivacaine (F, 92 +/- 39 minutes; FB, 125 +/- 31 minutes; FBE, 134 +/- 42 minutes; and FE, 117 +/- 48 minutes). Intrathecal epinephrine was associated with a higher incidence of severe nausea (P =.001), and the FBE group had more lower extremity weakness (P =.047). There was no difference in the incidence of severe pruritus, FHR deceleration, or delivery outcome between the groups. CONCLUSIONS: These results suggest that intrathecal epinephrine does not prolong the duration of fentanyl or fentanyl with bupivacaine for labor analgesia in nulliparous parturients. Additionally, intrathecal epinephrine did not decrease the incidence of side effects and therefore cannot be recommended.
PMID: 12132061, UI: 22127003
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