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Local infiltration of epinephrine-containing lidocaine with bicarbonate reduces superficial bleeding and pain during labor epidural catheter insertion: a randomized trial

Published:February 07, 2007DOI:https://doi.org/10.1016/j.ijoa.2006.09.006

      Background

      Superficial bleeding after labor epidural catheter placement is a common phenomenon. In addition to delaying securing the epidural catheter, it may loosen the adhesive catheter dressing. The primary aim of this study was to determine whether skin infiltration with epinephrine-containing rather than plain lidocaine reduces superficial bleeding after catheter placement. Secondary objectives were to determine whether adding epinephrine and/or sodium bicarbonate affected infiltration pain.

      Methods

      After institutional review board approval and informed consent, 80 healthy women receiving epidural analgesia during labor were randomly assigned in a double-blind manner to four local anesthetic mixtures (n = 20 in each group): group L: lidocaine 1.5%, group LB: lidocaine 1.5% with 8.4% sodium bicarbonate, group LE: lidocaine 1.5% with epinephrine 1:200000, and group LEB: lidocaine 1.5% with epinephrine 1:200000 and 8.4% sodium bicarbonate. Clinical endpoints included the amount of superficial bleeding at the catheter site, pain during local anesthetic infiltration and epidural catheter movement during labor.

      Results

      Demographic data were similar among the groups. The addition of epinephrine to lidocaine significantly reduced superficial bleeding. Solutions containing epinephrine were well tolerated and caused no cardiovascular disturbances. The addition of epinephrine did not increase pain, while bicarbonate reduced it [verbal score (scale 0-10) 3.6 ± 2.2 vs. 2.6 ± 1.8; P = 0.04]. There were no differences in epidural catheter movement among the groups; no catheters became displaced during labor.

      Conclusion

      Local infiltration of epinephrine-containing lidocaine before epidural catheter insertion reduces superficial bleeding and the addition of bicarbonate decreases pain during skin infiltration.

      Keywords

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      References

        • Metaxotos N.G.
        • Asplund O.
        • Hayes M.
        The efficacy of bupivacaine with adrenaline in reducing pain and bleeding associated with breast reduction: a prospective trial.
        Br J Plast Surg. 1999; 52: 290-293
        • Ginstrom R.
        • Silvola J.
        • Saarnivaara L.
        Local bupivacaine-epinephrine infiltration combined with general anesthesia for adult tonsillectomy.
        Acta Otolaryngol. 2005; 125: 972-975
        • Sorensen W.T.
        • Wagner N.
        • Aarup A.T.
        • Bonding P.
        Beneficial effect of low-dose peritonsillar injection of lidocaine-adrenaline before tonsillectomy.
        A placebo-controlled clinical trial. Auris Nasus Larynx. 2003; 30: 159-162
        • Nisar A.
        • Shabbir J.
        • Tubassam M.A.
        • et al.
        Local anaesthetic flush reduces postoperative pain and haematoma formation after great saphenous vein stripping–a randomised controlled trial.
        Eur J Vasc Endovasc Surg. 2006; 31: 325-331
        • Thomas S.S.
        • Srivastava S.
        • Nancarrow J.D.
        • Mohmand M.H.
        Dilute adrenaline infiltration and reduced blood loss in reduction mammaplasty.
        Ann Plast Surg. 1999; 43: 127-131
        • Hafner H.M.
        • Rocken M.
        • Breuninger H.
        Epinephrine-supplemented local anesthetics for ear and nose surgery: clinical use without complications in more than 10,000 surgical procedures.
        J Dtsch Dermatol Ges. 2005; 3: 195-199
        • McKay W.
        • Morris R.
        • Mushlin P.
        Sodium bicarbonate attenuates pain on skin infiltration with lidocaine, with or without epinephrine.
        Anesth Analg. 1987; 66: 572-574
        • Palmon S.C.
        • Lloyd A.T.
        • Kirsch J.R.
        The effect of needle gauge and lidocaine pH on pain during intradermal injection.
        Anesth Analg. 1998; 86: 379-381
        • Nakayama M.
        • Munemura Y.
        • Kanaya N.
        • Tsuchida H.
        • Namiki A.
        Efficacy of alkalinized lidocaine for reducing pain on intravenous and epidural catheterization.
        J Anesth. 2001; 15: 201-203
        • Armel H.E.
        • Horowitz M.
        Alkalinization of local anesthesia with sodium bicarbonate–preferred method of local anesthesia.
        Urology. 1994; 43: 101
        • Martin A.J.
        pH-adjustment and discomfort caused by the intradermal injection of lignocaine.
        Anaesthesia. 1990; 45: 975-978
        • Steinbrook R.A.
        • Hughes N.
        • Fanciullo G.
        • Manzi D.
        • Ferrante F.M.
        Effects of alkalinization of lidocaine on the pain of skin infiltration and intravenous catheterization.
        J Clin Anesth. 1993; 5: 456-458
        • Parham S.M.
        • Pasieka J.L.
        Effect of pH modification by bicarbonate on pain after subcutaneous lidocaine injection.
        Can J Surg. 1996; 39: 31-35
        • Richtsmeier A.J.
        • Hatcher J.W.
        Buffered lidocaine for skin infiltration prior to hemodialysis.
        J Pain Symptom Manage. 1995; 10: 198-203
        • Serour F.
        • Levine A.
        • Mandelberg A.
        • Ben Yehuda Y.
        • Boaz M.
        • Mori J.
        Alkalinizing local anesthetic does not decrease pain during injection for dorsal penile nerve block.
        J Clin Anesth. 1999; 11: 563-566
        • Gershon R.Y.
        • Mokriski B.K.
        • Matjasko M.J.
        Intradermal anesthesia and comparison of intravenous catheter gauge.
        Anesth Analg. 1991; 73: 469-470
        • Chassard D.
        • Berrada K.
        • Bouletreau P.
        Alkalinization of local anesthetics: theoretically justified but clinically useless.
        Can J Anaesth. 1996; 43: 384-393
        • Morris R.
        • McKay W.
        • Mushlin P.
        Comparison of pain associated with intradermal and subcutaneous infiltration with various local anesthetic solutions.
        Anesth Analg. 1987; 66: 1180-1182
        • Connelly N.R.
        • Leonard R.
        Discomfort associated with regional anesthetic placement in obstetrics: does alkalinization help?.
        Int J Obstet Anesth. 1996; 5: 89-91
        • Burns C.A.
        • Ferris G.
        • Feng C.
        • Cooper J.Z.
        • Brown M.D.
        Decreasing the pain of local anesthesia: a prospective, double-blind comparison of buffered, premixed 1% lidocaine with epinephrine versus 1% lidocaine freshly mixed with epinephrine.
        J Am Acad Dermatol. 2006; 54: 128-131
        • Biswas B.K.
        • Bithal P.K.
        • Dash H.H.
        Cardiovascular responses to scalp infiltration with reduced concentration of adrenaline.
        Neurol India. 2002; 50: 168-173
        • Murthy H.S.
        • Rao G.S.
        Cardiovascular responses to scalp infiltration with different concentrations of epinephrine with or without lidocaine during craniotomy.
        Anesth Analg. 2001; 92: 1516-1519