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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Article info
Publication history
Published online: February 07, 2007
Accepted:
September 1,
2006
B. Carvalho MB, BCh, FRCA, and S.E. Cohen MB, Ch.B, FRCA, Department of Anesthesia, Stanford University School of Medicine, Stanford, California; A. Fuller MD, Current affiliation: Private practice, Northern Colorado Anesthesia Professional Consultants, Fort Collins, Colorado; C. Brummel MD, Current affiliation: Private practice, Colorado Permanente Medical Group, Denver, Colorado, USA.Footnotes
☆The study was conducted at Lucile Packard Children’s Hospital and Stanford University School of Medicine, Stanford, California and funded internally by the Department of Anesthesia, Stanford University School of Medicine.
☆☆Findings from this study were presented at the 37th Annual Meeting of the Society for Obstetric Anesthesia and Perinatology (SOAP), May 2005, Palm Springs, California.
Identification
Copyright
© 2006 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
