Effect of Epidural Epinephrine on the Minimum Local Analgesic Concentration of Epidural Bupivacaine in Labor

2002 ◽  
Vol 96 (5) ◽  
pp. 1123-1128 ◽  
Author(s):  
Linda S. Polley ◽  
Malachy O. Columb ◽  
Norah N. Naughton ◽  
Deborah S. Wagner ◽  
Cosmas J. M. van de Ven
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Confidence Interval ◽  
Epidural Analgesia ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Maternal Blood ◽  
Double Blind ◽  
Clinically Significant ◽  
Maternal Blood Pressure

Background The minimum local analgesic concentration (MLAC) has been defined as the median effective local analgesic concentration in a 20-ml volume for epidural analgesia in the first stage of labor. The aim of this study was to determine the local anesthetic-sparing efficacy of epidural epinephrine by its effect on the MLAC of bupivacaine. Methods In this double-blind, randomized, prospective study, 70 parturients who were at 7 cm or less cervical dilation and who requested epidural analgesia were allocated to one of two groups. After lumbar epidural catheter placement, 20 ml bupivacaine (n = 35) or bupivacaine with epinephrine 1:300,000 (n = 35) was administered. The concentration of bupivacaine was determined by the response of the previous patient in that group to a higher or lower concentration using up-down sequential allocation. Analgesic efficacy was assessed using 100-mm visual analog pain scores, with 10 mm or less within 30 min defined as effective. Results The MLAC of bupivacaine alone was 0.091% wt/vol (95% confidence interval, 0.081-0.102). The addition of epinephrine 1:300,000 (66.7 microg) resulted in a significant reduction (P < 0.01) in the MLAC of bupivacaine to 0.065% wt/vol (95% confidence interval, 0.047-0.083). The lowest maternal blood pressure was significantly lower in the bupivacaine-epinephrine group (P = 0.03). There were statistically significant reductions in fetal heart rate (P = 0.011) in the bupivacaine-epinephrine group that were not clinically significant. Conclusions The addition of epidural epinephrine 1:300,000 (66 microg) resulted in a significant 29% reduction in the MLAC of bupivacaine. Coincident reductions in fetal heart rate and maternal blood pressure were also observed that were not clinically significant.

TELEMETRY OF FETAL HEART RATE AND MATERNAL BLOOD PRESSURE FROM HOME

1990 ◽  
Vol 18 (s1) ◽  
pp. 25-25
Author(s):  
K.J. Dalton ◽  
P. Mooney ◽  
W. Cartwright ◽  
H. Swindells ◽  
S. Rushant
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Maternal Blood ◽  
Maternal Blood Pressure

Analgesic and Hemodynamic Effects of Intrathecal Clonidine as the Sole Analgesic Agent during First Stage of Labor 

1999 ◽  
Vol 91 (2) ◽  
pp. 388-396 ◽  
Author(s):  
Astrid Chiari ◽  
Christine Lorber ◽  
James C. Eisenach ◽  
Eckart Wildling ◽  
Claus Krenn ◽  
...  
Keyword(s):  
Heart Rate ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Maternal Blood ◽  
Labor Analgesia ◽  
Double Blind Study ◽  
Double Blind ◽  
Intrathecal Clonidine ◽  
Dose Dependent ◽  
First Stage Of Labor

Background Intrathecal clonidine produces dose-dependent postoperative analgesia and enhances labor analgesia from intrathecal sufentanil. The authors evaluated the dose-response potency of intrathecally administered clonidine by itself during first stage of labor with respect to analgesia and maternal and fetal side effects. Methods Thirty-six parturients requesting labor analgesia were included in this prospective, randomized, double-blind study. Parturients with < 6 cm cervical dilatation received either 50, 100, or 200 microg intrathecal clonidine. The authors recorded visual analog pain score (VAPS), maternal blood pressure and heart rate, ephedrine requirements, and sedation at regular intervals and fetal heart rate tracings continuously. Duration of analgesia was defined as time from intrathecal clonidine administration until request for additional analgesia. Results Clonidine produced a reduction in VAPS with all three doses. The duration of analgesia was significantly longer in patients receiving 200 microg (median, 143; range, 75-210 min) and 100 microg (median, 118; range, 60-180 min) than 50 microg (median, 45; range, 25-150 min), and VAPS was lower in the 200-microg than in the 50-microg group. In the 200-microg group, hypotension required significantly more often treatment with ephedrine than in the other groups. No adverse events or fetal heart rate abnormalities occurred. Conclusions Fifty to 200 microg intrathecal clonidine produces dose-dependent analgesia during first stage of labor. Although duration and quality of analgesia were more pronounced with 100 and 200 microg than with 50 microg, the high incidence of hypotension requires caution with the use of 200 microg for labor analgesia.

Combined spinal epidural analgesia for labor using sufentanil epidurally versus intrathecally: a retrospective study on the influence on fetal heart trace

2015 ◽  
Vol 43 (4) ◽  
Author(s):  
Nele Everaert ◽  
Marc Coppens ◽  
Peter Vlerick ◽  
Geert Braems ◽  
Patrick Wouters ◽  
...  
Keyword(s):  
Heart Rate ◽  
Retrospective Study ◽  
Epidural Analgesia ◽  
Fetal Heart Rate ◽  
Neonatal Outcome ◽  
Fetal Heart ◽  
Uterine Activity ◽  
Combined Spinal Epidural ◽  
Spinal Epidural ◽  
Intrathecal Space

AbstractWe retrospectively compared a protocol using sufentanil and ropivacaine intrathecally with a protocol in which only ropivacaine was administered intrathecally and sufentanil was used epidurally to evaluate whether banning sufentanil from the intrathecal space results in a decreased incidence of adverse fetal heart rate changes.Some 520 cardiotocographic tracings were examined for changes in fetal heart rate and uterine activity following two different protocols of combined spinal epidural analgesia. Charts were consulted for neonatal and labor outcome.When sufentanil was used epidurally instead of intrathecally, the incidence of adverse changes in fetal heart trace was less, demonstrated by a higher percentage of normal reassuring tracings (74.5% vs. 60.4% when sufentanil was used intrathecally; P=0.007), less tracings showing bradycardia (7.5% vs. 14.1%; P=0.035), and more tracings displaying 3 or more accelerations in fetal heart rate in 45 min (93.5% vs. 83.9%; P=0.003) together with less episodes of tachycardia (3.5% vs. 11.4%; P=0.005). There were no differences in labor and neonatal outcome.Based on fetal heart tracing, it seems favorable to ban sufentanil from the intrathecal compartment.

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