==================================CMR48==================================
48.  Epinephrine containing solutions used in the pregnant patient.  
     Especially local anesthetics.
1
UI  - 87123404
AU  - Grenman S ; Erkkola R ; Kanto J ; Scheinin M ; Viinam:aki O ;
      Lindberg R
TI  - Epidural and paracervical blockades in obstetrics.
      Catecholamines, arginine vasopressin and analgesic effect.
AB  - A comparative study of analgesic and endocrinologic effects of
      obstetrical epidural anesthesia (EA, n = 23) and paracervical
      block (PCB, n = 39) was performed. Pain intensity was assessed on
      a horizontal linear scale. Simultaneously, blood samples for the
      determination of concentrations of norepinephrine (NE),
      epinephrine (E) and arginine vasopressin (AVP) were obtained. NE
      and AVP levels did not bear any relationship to pain scores.
      Instead, the average plasma E profile during labor was
      practically identical with the profile of pain scores. Plasma
      levels of E decreased significantly after EA. A similar but
      short-lived effect was observed also after PCB. When comparable
      doses of bupivacaine were used (30 mg in the EA group and 25 mg
      in the PCB group); initial pain relief after EA and PCB was
      similar, though after 30 min the pain score increased for
      patients who received the PCB, while patients who received EA had
      continued pain relief. Faster absorption of bupivacaine was
      observed after paracervical than epidural injection. Decreased
      variability was seen in the fetal cardiograms in 25% after EA and
      in 33% after PCB. Transient bradycardia was observed in 2 cases
      after paracervical injection.
MH  - Adult ; *Anesthesia, Epidural ; *Anesthesia, Obstetrical ;
      Argipressin/*BLOOD ; Bupivacaine ; Cervix Uteri/DRUG EFFECTS ;
      Comparative Study ; Epinephrine/*BLOOD ; Female ; Human ; *Nerve
      Block ; Norepinephrine/*BLOOD ; Pain Measurement ; Pregnancy
SO  - Acta Obstet Gynecol Scand 1986;65(7):699-704
2
UI  - 87051034
AU  - Douglas MJ ; Kim JH ; Ross PL ; McMorland GH
TI  - The effect of epinephrine in local anaesthetic on epidural
      morphine-induced pruritus.
AB  - The severity of epidural morphine-induced pruritus was evaluated
      following the addition of epinephrine to the local anaesthetic
      solution used for Caesarean section anaesthesia. The local
      anaesthetic solutions used were: Group I--0.5 per cent
      bupivacaine plain--20 patients. Group II--0.5 per cent
      bupivacaine with 1:400,000 epinephrine--25 patients. Group
      III--0.5 per cent bupivacaine with 1:200,000 epinephrine for the
      3 ml "test dose: followed by 0.5 per cent bupivacaine plain for
      anaesthesia--21 patients. The severity of the pruritus, as
      measured by completion of a visual analogue "itch scale: and by
      requests for medication for pruritus, was statistically
      significantly greater in both groups in which epinephrine was
      added. This effect was not dose-related, as the "test dose: group
      (15 micrograms epinephrine) experienced the most severe itch.
      This latter difference was also statistically significant (p less
      than 0.05).
MH  - Anesthetics, Local/*ADVERSE EFFECTS ; Cesarean Section ;
      Epinephrine/*ADVERSE EFFECTS ; Female ; Human ; Injections,
      Epidural ; Morphine/*ADVERSE EFFECTS ; Pregnancy ; Pruritus/
      *CHEMICALLY INDUCED
SO  - Can Anaesth Soc J 1986 Nov;33(6):737-40