Combined epidural lidocaine-fentanyl-epinephrine for cesarean section

The combined use of fentanyl-epinephrine-lidocaine in epidural analgesia was investigated in 60 mothers who underwent elective Cesarean section. They were randomly classified into 4 groups of 15 each. Group A received 20 mL of 2% lidocaine 3 mL normal saline. Group B received 20 mL of 2% lidocaine with freshly added 1:200000 epinephrine and 5 mL normal saline. Group C received 20 mL of 2% lidocaine and 2 mL of fentanyl in 3 mL normal saline. Group D received 20 mL of 2% lidocaine and 5 mL normal saline. The duration of action was nearly doubled in the groups with epinephrine added. The quality of the analgesia was assessed by the degree of intraoperative analgesia; 93% of the patients in group A were classified as "Excellent"; while only 67% in group B were classified as "Excellent". The difference in patient's acceptance was statistically significant. 93% vs 27% in Group A and Group C; 67% vs 6.7% in Group B and Group D rated "Excellent". The results suggest that both fentanyl and epinephrine improve intraoperative analgesia. Epinephrine offers a greater analgesic effect than fentanyl.