Effects of epinephrine in the epidural space on the incidence of blood vessel injury by epidural catheter insertion for cesarean section: a prospective, randomized, double-blind study

Study objective: To evaluate the effects of epinephrine (1:200,000) in the epidural space on the incidence of blood vessel injury by epidural catheter insertion for cesarean section. Design: Prospective observational study. Setting: University-affiliated teaching hospital. Patients: Four hundred laboring women with singleton cephalic presentations at term who underwent cesarean section and requested continuous epidural analgesia. Interventions: Predistension of 5 mL of isotonic sodium chloride solution containing epinephrine (1:200,000) or 5 mL of isotonic sodium chloride solution through an epidural needle before catheter insertion. Measurements: Cases with bloody fluid in the epidural needle or catheter during catheter insertion, aspiration of frank blood from the epidural catheter, and blood noted in the caudal end of the epidural catheter upon removal were recorded. Main results: Eight parturients were excluded from the analysis for technical reasons. There were no significant differences between patients in the 2 groups with respect to cases with bloody fluid in the epidural needle during catheter insertion (7.6% vs 9.8%, P = .44), the epidural catheter during catheter placement (6.0% vs 6.7%, P = .80), aspiration of frank blood in the epidural catheter (1.0% vs 1.0 %, P = .98), and blood noted in the caudal end of the epidural catheter upon removal (27.3% vs 30.4 %; P > .49). Conclusion: Twenty-five micrograms of epinephrine (1:200,000) in the epidural space does not reduce the incidence of blood vessel injury induced by insertion of an epidural catheter. (C) 2014 Elsevier Inc. All rights reserved.