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The Effect of Adding Intrathecal Epinephrine to Hyperbaric Bupivacaine and Preservative Free Morphine for Repeat Cesarean Delivery: A Double Blind Prospective Randomized Control Trial
Abstract Number: F-28
Abstract Type: Original Research
Background: Spinal anesthesia has become the most common type of anesthetic for cesarean delivery. The major limitation to spinal anesthesia is that the duration of the anesthetic may be outlasted by the increased operative time. Some practitioners add epinephrine to hyperbaric bupivacaine to increase the duration, although its effect has not been fully studied. We therefore aimed to evaluate whether adding epinephrine to the spinal medication prolongs the duration of action of the resultant block.
Methods: Sixty-eight patients were randomized to receive no epinephrine (NE group), 100 mcg (LD group), or 200 mcg (HD group) with a standardized spinal mixture (1.5 ml 0.75% hyperbaric bupivacaine with 0.25 mg morphine). Our primary outcome, regression of sensory blockade to T10 dermatome level, was measured by pinprick sensation; motor recovery was graded via a modified Bromage scale.
Results: Block onset time, vital sign changes, as well as the incidence of hypotension; nausea, and vomiting were similar between groups. Time to T-10 regression was significantly greater in the HD group (Median [95%CI] HD: 165 min [150-180], LD: 135 min [120-150], NE: 120 min [45-150]; p<0.001). The time to knee extension was also greatest in the HD group (Median [95% CI] HD: 172 min [150-210], LD: 150 min [135-150], NE: 120 min [105-120]; p<0.001).
Conclusions: In this single center, prospective, double-blind, randomized control trial, the addition of epinephrine 200 mcg to hyperbaric bupivacaine and preservative free morphine for cesarean section prolonged the duration of both the sensory and motor blockade and may have also enhanced block quality.