Epinephrine decreases the dose of hyperbaric bupivacaine necessary for tourniquet pain blockade during spinal anesthesia for total knee replacement arthroplasty
Purpose We quantified the dose-sparing effect of epinephrine by comparing the median effective dose (ED 50 ) of intrathecal hyperbaric bupivacaine co-administered with epinephrine with the ED 50 of intrathecal hyperbaric bupivacaine alone. Methods Three groups were randomly generated from 162 patien...
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| Veröffentlicht in: | Journal of anesthesia 2013-02, Vol.27 (1), p.72-79 |
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| creator | Kim, Won Ho Ko, Justin Sangwook Ahn, Hyun Joo Choi, Soo Joo Shin, Byung Seop Gwak, Mi Sook Sim, Woo Seog Yang, Mikyung |
| description | Purpose
We quantified the dose-sparing effect of epinephrine by comparing the median effective dose (ED
50
) of intrathecal hyperbaric bupivacaine co-administered with epinephrine with the ED
50
of intrathecal hyperbaric bupivacaine alone.
Methods
Three groups were randomly generated from 162 patients undergoing total knee replacement arthroplasty under combined spinal and epidural anesthesia: Group B (bupivacaine), Group BE1 (bupivacaine plus epinephrine 100 μg), and Group BE2 (bupivacaine plus epinephrine 200 μg). Each group was further divided by bupivacaine doses of 6, 7, 8, 9, 10, or 11 mg. The anesthesia was defined as successful if a bilateral T12 sensory block occurred within 15 min, and no intraoperative epidural supplement was required. The ED
50
and ED
95
for successful anesthesia and successful tourniquet pain blockade were determined separately by probit regression analysis.
Results
The ED
50
and ED
95
of intrathecal hyperbaric bupivacaine for successful anesthesia were not different among the groups: the ED
50
values were 7.1 mg [95 % confidence interval (95 % CI) 6.0–8.0 mg] in Group B, 6.2 mg (95 % CI 4.8–7.2 mg) in Group BE1, and 6.3 mg (95 % CI 4.9–7.2 mg) in Group BE2. However, the ED
50
and ED
95
values for tourniquet pain control were significantly smaller in Groups BE1 and BE2 than in Group B: the ED
50
values were 7.2 mg (95 % CI 6.3–7.9 mg), 5.5 mg (95 % CI 4.1–6.3 mg), and 5.3 mg (95 % CI 3.7–6.2 mg) in Groups B, BE1, and BE2, respectively. The incidence of tourniquet pain was significantly lower in Groups BE1 and BE2 than in Group B. The time to patients’ requests for supplemental analgesia was significantly longer in Groups BE1 and BE2 than in Group B.
Conclusions
Intrathecal epinephrine did not decrease the dose of intrathecal hyperbaric bupivacaine required for successful anesthesia. However, it reduced the dose required for tourniquet pain blockade. |
| doi_str_mv | 10.1007/s00540-012-1471-x |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_1288991871</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A334040930</galeid><sourcerecordid>A334040930</sourcerecordid><originalsourceid>FETCH-LOGICAL-c502t-befd86334af0e7b6ba11be7f0fb9bae8f8e238d9f652ccf1c9c9e54f4002582b3</originalsourceid><addsrcrecordid>eNp9ks2KFDEUhQtRnHb0AdxIwI2bGpPUX7IchhkVBtzoOiSpm-7MVFXKJCXTb-OjeotqBaGRQEKS75z83FMUbxm9YpR2HxOlTU1LynjJ6o6VT8-KHasrUYqqkc-LHZWsKkXbioviVUoPlNKWseplccG5ZIzzalf8up39BPMhYk96sBF0gkTyAWchAQmOHI4zRKOjt8Qss_-prV7hCSykpOORuBBJDkuc_I8FMplxm5gh2Efdo8uC1nuS8Bg9ED1BQu_k9UmVcfFxAiAR5kFbGGHKRMd8iAHnKR9fFy-cHhK8OY2Xxfe72283n8v7r5--3Fzfl7ahPJcGXC_aqqq1o9CZ1mjGDHSOOiONBuEE8Er00rUNt9YxK62EpnY1pbwR3FSXxYfNd44Bn5GyGn2yMAx45bAkxbgQUjLRMUTfb-heD6D85EKO2q64usYb0JrKiiJVnqH2MEHUQ5jAeVz-h786w2PrYfT2rIBtAhtDShGcmqMfsSCKUbXmQ235UJgPteZDPaHm3emVixmh_6v4EwgE-Aakea0bRPWwVhZ__j-uvwHSvcnc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1288991871</pqid></control><display><type>article</type><title>Epinephrine decreases the dose of hyperbaric bupivacaine necessary for tourniquet pain blockade during spinal anesthesia for total knee replacement arthroplasty</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Kim, Won Ho ; Ko, Justin Sangwook ; Ahn, Hyun Joo ; Choi, Soo Joo ; Shin, Byung Seop ; Gwak, Mi Sook ; Sim, Woo Seog ; Yang, Mikyung</creator><creatorcontrib>Kim, Won Ho ; Ko, Justin Sangwook ; Ahn, Hyun Joo ; Choi, Soo Joo ; Shin, Byung Seop ; Gwak, Mi Sook ; Sim, Woo Seog ; Yang, Mikyung</creatorcontrib><description>Purpose
We quantified the dose-sparing effect of epinephrine by comparing the median effective dose (ED
50
) of intrathecal hyperbaric bupivacaine co-administered with epinephrine with the ED
50
of intrathecal hyperbaric bupivacaine alone.
Methods
Three groups were randomly generated from 162 patients undergoing total knee replacement arthroplasty under combined spinal and epidural anesthesia: Group B (bupivacaine), Group BE1 (bupivacaine plus epinephrine 100 μg), and Group BE2 (bupivacaine plus epinephrine 200 μg). Each group was further divided by bupivacaine doses of 6, 7, 8, 9, 10, or 11 mg. The anesthesia was defined as successful if a bilateral T12 sensory block occurred within 15 min, and no intraoperative epidural supplement was required. The ED
50
and ED
95
for successful anesthesia and successful tourniquet pain blockade were determined separately by probit regression analysis.
Results
The ED
50
and ED
95
of intrathecal hyperbaric bupivacaine for successful anesthesia were not different among the groups: the ED
50
values were 7.1 mg [95 % confidence interval (95 % CI) 6.0–8.0 mg] in Group B, 6.2 mg (95 % CI 4.8–7.2 mg) in Group BE1, and 6.3 mg (95 % CI 4.9–7.2 mg) in Group BE2. However, the ED
50
and ED
95
values for tourniquet pain control were significantly smaller in Groups BE1 and BE2 than in Group B: the ED
50
values were 7.2 mg (95 % CI 6.3–7.9 mg), 5.5 mg (95 % CI 4.1–6.3 mg), and 5.3 mg (95 % CI 3.7–6.2 mg) in Groups B, BE1, and BE2, respectively. The incidence of tourniquet pain was significantly lower in Groups BE1 and BE2 than in Group B. The time to patients’ requests for supplemental analgesia was significantly longer in Groups BE1 and BE2 than in Group B.
Conclusions
Intrathecal epinephrine did not decrease the dose of intrathecal hyperbaric bupivacaine required for successful anesthesia. However, it reduced the dose required for tourniquet pain blockade.</description><identifier>ISSN: 0913-8668</identifier><identifier>EISSN: 1438-8359</identifier><identifier>DOI: 10.1007/s00540-012-1471-x</identifier><identifier>PMID: 22911223</identifier><language>eng</language><publisher>Japan: Springer Japan</publisher><subject>Aged ; Analgesia ; Analysis ; Anesthesia ; Anesthesia, Epidural ; Anesthesia, Spinal - methods ; Anesthesiology ; Anesthetics, Local - administration & dosage ; Arthroplasty, Replacement, Knee - methods ; Blood Pressure - drug effects ; Bupivacaine ; Bupivacaine - administration & dosage ; Critical Care Medicine ; Dosage and administration ; Drug therapy ; Emergency Medicine ; Endpoint Determination ; Epinephrine ; Epinephrine - pharmacology ; Female ; Health aspects ; Humans ; Intensive ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Article ; Pain - prevention & control ; Pain Measurement ; Pain Medicine ; Sample Size ; Tourniquets - adverse effects ; Vasoconstrictor Agents - pharmacology</subject><ispartof>Journal of anesthesia, 2013-02, Vol.27 (1), p.72-79</ispartof><rights>Japanese Society of Anesthesiologists 2012</rights><rights>COPYRIGHT 2013 Springer</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c502t-befd86334af0e7b6ba11be7f0fb9bae8f8e238d9f652ccf1c9c9e54f4002582b3</citedby><cites>FETCH-LOGICAL-c502t-befd86334af0e7b6ba11be7f0fb9bae8f8e238d9f652ccf1c9c9e54f4002582b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00540-012-1471-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00540-012-1471-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,777,781,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22911223$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kim, Won Ho</creatorcontrib><creatorcontrib>Ko, Justin Sangwook</creatorcontrib><creatorcontrib>Ahn, Hyun Joo</creatorcontrib><creatorcontrib>Choi, Soo Joo</creatorcontrib><creatorcontrib>Shin, Byung Seop</creatorcontrib><creatorcontrib>Gwak, Mi Sook</creatorcontrib><creatorcontrib>Sim, Woo Seog</creatorcontrib><creatorcontrib>Yang, Mikyung</creatorcontrib><title>Epinephrine decreases the dose of hyperbaric bupivacaine necessary for tourniquet pain blockade during spinal anesthesia for total knee replacement arthroplasty</title><title>Journal of anesthesia</title><addtitle>J Anesth</addtitle><addtitle>J Anesth</addtitle><description>Purpose
We quantified the dose-sparing effect of epinephrine by comparing the median effective dose (ED
50
) of intrathecal hyperbaric bupivacaine co-administered with epinephrine with the ED
50
of intrathecal hyperbaric bupivacaine alone.
Methods
Three groups were randomly generated from 162 patients undergoing total knee replacement arthroplasty under combined spinal and epidural anesthesia: Group B (bupivacaine), Group BE1 (bupivacaine plus epinephrine 100 μg), and Group BE2 (bupivacaine plus epinephrine 200 μg). Each group was further divided by bupivacaine doses of 6, 7, 8, 9, 10, or 11 mg. The anesthesia was defined as successful if a bilateral T12 sensory block occurred within 15 min, and no intraoperative epidural supplement was required. The ED
50
and ED
95
for successful anesthesia and successful tourniquet pain blockade were determined separately by probit regression analysis.
Results
The ED
50
and ED
95
of intrathecal hyperbaric bupivacaine for successful anesthesia were not different among the groups: the ED
50
values were 7.1 mg [95 % confidence interval (95 % CI) 6.0–8.0 mg] in Group B, 6.2 mg (95 % CI 4.8–7.2 mg) in Group BE1, and 6.3 mg (95 % CI 4.9–7.2 mg) in Group BE2. However, the ED
50
and ED
95
values for tourniquet pain control were significantly smaller in Groups BE1 and BE2 than in Group B: the ED
50
values were 7.2 mg (95 % CI 6.3–7.9 mg), 5.5 mg (95 % CI 4.1–6.3 mg), and 5.3 mg (95 % CI 3.7–6.2 mg) in Groups B, BE1, and BE2, respectively. The incidence of tourniquet pain was significantly lower in Groups BE1 and BE2 than in Group B. The time to patients’ requests for supplemental analgesia was significantly longer in Groups BE1 and BE2 than in Group B.
Conclusions
Intrathecal epinephrine did not decrease the dose of intrathecal hyperbaric bupivacaine required for successful anesthesia. However, it reduced the dose required for tourniquet pain blockade.</description><subject>Aged</subject><subject>Analgesia</subject><subject>Analysis</subject><subject>Anesthesia</subject><subject>Anesthesia, Epidural</subject><subject>Anesthesia, Spinal - methods</subject><subject>Anesthesiology</subject><subject>Anesthetics, Local - administration & dosage</subject><subject>Arthroplasty, Replacement, Knee - methods</subject><subject>Blood Pressure - drug effects</subject><subject>Bupivacaine</subject><subject>Bupivacaine - administration & dosage</subject><subject>Critical Care Medicine</subject><subject>Dosage and administration</subject><subject>Drug therapy</subject><subject>Emergency Medicine</subject><subject>Endpoint Determination</subject><subject>Epinephrine</subject><subject>Epinephrine - pharmacology</subject><subject>Female</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Intensive</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Pain - prevention & control</subject><subject>Pain Measurement</subject><subject>Pain Medicine</subject><subject>Sample Size</subject><subject>Tourniquets - adverse effects</subject><subject>Vasoconstrictor Agents - pharmacology</subject><issn>0913-8668</issn><issn>1438-8359</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ks2KFDEUhQtRnHb0AdxIwI2bGpPUX7IchhkVBtzoOiSpm-7MVFXKJCXTb-OjeotqBaGRQEKS75z83FMUbxm9YpR2HxOlTU1LynjJ6o6VT8-KHasrUYqqkc-LHZWsKkXbioviVUoPlNKWseplccG5ZIzzalf8up39BPMhYk96sBF0gkTyAWchAQmOHI4zRKOjt8Qss_-prV7hCSykpOORuBBJDkuc_I8FMplxm5gh2Efdo8uC1nuS8Bg9ED1BQu_k9UmVcfFxAiAR5kFbGGHKRMd8iAHnKR9fFy-cHhK8OY2Xxfe72283n8v7r5--3Fzfl7ahPJcGXC_aqqq1o9CZ1mjGDHSOOiONBuEE8Er00rUNt9YxK62EpnY1pbwR3FSXxYfNd44Bn5GyGn2yMAx45bAkxbgQUjLRMUTfb-heD6D85EKO2q64usYb0JrKiiJVnqH2MEHUQ5jAeVz-h786w2PrYfT2rIBtAhtDShGcmqMfsSCKUbXmQ235UJgPteZDPaHm3emVixmh_6v4EwgE-Aakea0bRPWwVhZ__j-uvwHSvcnc</recordid><startdate>20130201</startdate><enddate>20130201</enddate><creator>Kim, Won Ho</creator><creator>Ko, Justin Sangwook</creator><creator>Ahn, Hyun Joo</creator><creator>Choi, Soo Joo</creator><creator>Shin, Byung Seop</creator><creator>Gwak, Mi Sook</creator><creator>Sim, Woo Seog</creator><creator>Yang, Mikyung</creator><general>Springer Japan</general><general>Springer</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130201</creationdate><title>Epinephrine decreases the dose of hyperbaric bupivacaine necessary for tourniquet pain blockade during spinal anesthesia for total knee replacement arthroplasty</title><author>Kim, Won Ho ; Ko, Justin Sangwook ; Ahn, Hyun Joo ; Choi, Soo Joo ; Shin, Byung Seop ; Gwak, Mi Sook ; Sim, Woo Seog ; Yang, Mikyung</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c502t-befd86334af0e7b6ba11be7f0fb9bae8f8e238d9f652ccf1c9c9e54f4002582b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Analgesia</topic><topic>Analysis</topic><topic>Anesthesia</topic><topic>Anesthesia, Epidural</topic><topic>Anesthesia, Spinal - methods</topic><topic>Anesthesiology</topic><topic>Anesthetics, Local - administration & dosage</topic><topic>Arthroplasty, Replacement, Knee - methods</topic><topic>Blood Pressure - drug effects</topic><topic>Bupivacaine</topic><topic>Bupivacaine - administration & dosage</topic><topic>Critical Care Medicine</topic><topic>Dosage and administration</topic><topic>Drug therapy</topic><topic>Emergency Medicine</topic><topic>Endpoint Determination</topic><topic>Epinephrine</topic><topic>Epinephrine - pharmacology</topic><topic>Female</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Intensive</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Pain - prevention & control</topic><topic>Pain Measurement</topic><topic>Pain Medicine</topic><topic>Sample Size</topic><topic>Tourniquets - adverse effects</topic><topic>Vasoconstrictor Agents - pharmacology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kim, Won Ho</creatorcontrib><creatorcontrib>Ko, Justin Sangwook</creatorcontrib><creatorcontrib>Ahn, Hyun Joo</creatorcontrib><creatorcontrib>Choi, Soo Joo</creatorcontrib><creatorcontrib>Shin, Byung Seop</creatorcontrib><creatorcontrib>Gwak, Mi Sook</creatorcontrib><creatorcontrib>Sim, Woo Seog</creatorcontrib><creatorcontrib>Yang, Mikyung</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kim, Won Ho</au><au>Ko, Justin Sangwook</au><au>Ahn, Hyun Joo</au><au>Choi, Soo Joo</au><au>Shin, Byung Seop</au><au>Gwak, Mi Sook</au><au>Sim, Woo Seog</au><au>Yang, Mikyung</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Epinephrine decreases the dose of hyperbaric bupivacaine necessary for tourniquet pain blockade during spinal anesthesia for total knee replacement arthroplasty</atitle><jtitle>Journal of anesthesia</jtitle><stitle>J Anesth</stitle><addtitle>J Anesth</addtitle><date>2013-02-01</date><risdate>2013</risdate><volume>27</volume><issue>1</issue><spage>72</spage><epage>79</epage><pages>72-79</pages><issn>0913-8668</issn><eissn>1438-8359</eissn><abstract>Purpose
We quantified the dose-sparing effect of epinephrine by comparing the median effective dose (ED
50
) of intrathecal hyperbaric bupivacaine co-administered with epinephrine with the ED
50
of intrathecal hyperbaric bupivacaine alone.
Methods
Three groups were randomly generated from 162 patients undergoing total knee replacement arthroplasty under combined spinal and epidural anesthesia: Group B (bupivacaine), Group BE1 (bupivacaine plus epinephrine 100 μg), and Group BE2 (bupivacaine plus epinephrine 200 μg). Each group was further divided by bupivacaine doses of 6, 7, 8, 9, 10, or 11 mg. The anesthesia was defined as successful if a bilateral T12 sensory block occurred within 15 min, and no intraoperative epidural supplement was required. The ED
50
and ED
95
for successful anesthesia and successful tourniquet pain blockade were determined separately by probit regression analysis.
Results
The ED
50
and ED
95
of intrathecal hyperbaric bupivacaine for successful anesthesia were not different among the groups: the ED
50
values were 7.1 mg [95 % confidence interval (95 % CI) 6.0–8.0 mg] in Group B, 6.2 mg (95 % CI 4.8–7.2 mg) in Group BE1, and 6.3 mg (95 % CI 4.9–7.2 mg) in Group BE2. However, the ED
50
and ED
95
values for tourniquet pain control were significantly smaller in Groups BE1 and BE2 than in Group B: the ED
50
values were 7.2 mg (95 % CI 6.3–7.9 mg), 5.5 mg (95 % CI 4.1–6.3 mg), and 5.3 mg (95 % CI 3.7–6.2 mg) in Groups B, BE1, and BE2, respectively. The incidence of tourniquet pain was significantly lower in Groups BE1 and BE2 than in Group B. The time to patients’ requests for supplemental analgesia was significantly longer in Groups BE1 and BE2 than in Group B.
Conclusions
Intrathecal epinephrine did not decrease the dose of intrathecal hyperbaric bupivacaine required for successful anesthesia. However, it reduced the dose required for tourniquet pain blockade.</abstract><cop>Japan</cop><pub>Springer Japan</pub><pmid>22911223</pmid><doi>10.1007/s00540-012-1471-x</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0913-8668 |
| ispartof | Journal of anesthesia, 2013-02, Vol.27 (1), p.72-79 |
| issn | 0913-8668 1438-8359 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1288991871 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Aged Analgesia Analysis Anesthesia Anesthesia, Epidural Anesthesia, Spinal - methods Anesthesiology Anesthetics, Local - administration & dosage Arthroplasty, Replacement, Knee - methods Blood Pressure - drug effects Bupivacaine Bupivacaine - administration & dosage Critical Care Medicine Dosage and administration Drug therapy Emergency Medicine Endpoint Determination Epinephrine Epinephrine - pharmacology Female Health aspects Humans Intensive Male Medicine Medicine & Public Health Middle Aged Original Article Pain - prevention & control Pain Measurement Pain Medicine Sample Size Tourniquets - adverse effects Vasoconstrictor Agents - pharmacology |
| title | Epinephrine decreases the dose of hyperbaric bupivacaine necessary for tourniquet pain blockade during spinal anesthesia for total knee replacement arthroplasty |
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