Why the study?
Does 0.5% bupivacaine with epinephrine alter the onset and spread of sympathetic, sensory and motor blockade compared to plain bupivacaine in healthy women undergoing elective cesarean section?
Does 0.5% bupivacaine with epinephrine alter the onset and spread of sympathetic, sensory and motor blockade compared to plain bupivacaine in healthy women undergoing elective cesarean section?
Epinephrine addition improves epidural efficacy for cesarean delivery without altering onset or spread; reinforces selective adjuvant use in Level 2 evidence.
Forty healthy women scheduled for elective cesarean section under epidural anesthesia were randomly allocated to receive, in a double-blind manner, either 0.5% plain bupivacaine or 0.5% bupivacaine with 1:200,000 epinephrine. The drug was injected entirely through a Tuohy needle in fractionated doses: a 2 ml test dose followed by 18 ml injected over 5 minutes. Thereafter an epidural catheter was inserted and anesthesia and surgery managed routinely. Assessment was made of onset and spread of sympathetic, sensory and motor blockade. If sensory block was below T6 after 20 minutes, an additional 7 ml of anesthetic solution was injected via the catheter. Intra-operative discomfort was managed with intravenous narcotics (after delivery), further epidural drug, or inhalation agents.
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LAISHLEY et al. (1988) studied this question.
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