J Anesth Perioper Med. 2019;6(1):1-7. https://doi.org/10.24015/ebcmed.japm.2019.0002

Epinephrine on Continuous Epidural Pain Relief in Labor

Yunping Li1, Sanjeev Dalela2, Jan Kraemer3, Adrienne Kung1, Anasuya Vasudevan4, and Philip E. Hess1

From the 1Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; 2Department of Anesthesia, Sharecare, TX, USA; 3Interventional Pain Management, Presbyterian Community Hospital, San Juan, PR, USA; 4Geisinger Medical Center, Danville, PA, USA.

Correspondence to Dr. Philip E. Hess at phess@bidmc.harvard.edu.

EBCMED ID: ebcmed.japm.2019.0002 DOI: 10.24015/ebcmed.japm.2019.0002


Epidural pain relief in labor is commonly provided by a combination of local anesthetic and opioid. The opioid allows for a reduction in the concentration of local anesthetic, thus reducing side effects, while maintaining effective pain control. Epinephrine is an analgesic medication that may also improve pain control.

We conducted a prospective, randomized, double-blind study comparing an epidural infusion of bupivacaine 0.04%, fentanyl 1.66 μg/mL at a rate of 15 mL/h. Women were randomized to that solution (BF) or to the addition of epinephrine 1.67 μg/mL (BEF). Both solutions were administered at a rate of 15 mL/h. The primary outcome was the hourly frequency of breakthrough labor pain.

A total of 120 women were enrolled, and 100 completed the trial. On average, women had one episode of breakthrough pain throughout the course of their labor, with women who received epinephrine having fewer episodes (BF: 1.3 ± 1.1 vs. BEF: 0.7 ± 0.9; P = 0.002). The hourly rate of breakthrough pain was 52% lower in the group that received epinephrine (BF: 0.12 ± 0.15 vs. BEF: 0.25 ± 0.22; P = 0.002). There no differences between groups in pain scores or in side effects. Epinephrine did not affect the duration of labor with epidural analgesia (BF: 464 ± 310 min vs. BEF: 393 ± 214 min; P = 0.48).

The addition of a small amount of epinephrine to a low concentration, high volume epidural solution improves pain control and reduces the rate of breakthrough pain by half. There is no difference in side effects compared to a solution without epinephrine. (Funded by the Beth Israel Anesthesia Foundation, Boston, USA.)

Article Type
Original Article

Declaration of Interests
The authors have no other potential conflicts of interest for this work.

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