Intrathecal epinephrine for cesarean delivery and intraoperative fentanyl administration: a single-center...

Intrathecal epinephrine may be added to the local anesthetic to increase the duration and potentially improve analgesia of spinal block for cesarean delivery. We evaluated the association between intrathecal epinephrine as an adjunct for spinal anesthesia and intraoperative intravenous fentanyl administration.

This retrospective cohort study evaluated cesarean deliveries between 2018 and 2023 at a single institution. A total of 6,837 cesarean deliveries received spinal anesthesia and three groups were compared: no adjunct, 100 μg, and 200 μg epinephrine added to the protocolized spinal solution (hyperbaric bupivacaine 12 ± 0.5 mg, fentanyl 15 μg, and morphine 150 μg). The primary outcome was the percentage of patients receiving intraoperative fentanyl. Secondary outcomes were opioid consumption in the and time until discharge in the recovery unit.

The percentage of cases receiving no, 100 μg, and 200 μg epinephrine was 55%, 12%, and 33%, respectively. In a matched weights analysis adjusted for prior cesarean deliveries and parity, 7.7% of the no epinephrine group vs. 10.8% in the 200 μg epinephrine group (difference 3.1%, 95% CI 0.9% to 5.3%, P = 0.003) received intraoperative fentanyl. In the recovery unit, 2.7% in the no epinephrine group vs. 5.1% in the 200 μg of epinephrine group (difference - 2.4%, 95% CI -4.0% to -0.7%, P = 0.003) received an opioid. Recovery unit time was increased by six minutes in the 200 μg of epinephrine group (P = 0.003).

In this large retrospective study, intrathecal epinephrine (200 μg) as an adjunct to spinal anesthesia for cesarean delivery was not associated with a decrease in intravenous fentanyl administration intraoperatively; however, it was associated with a slightly longer time in the recovery unit. There does not appear to be a clinical intraoperative analgesic advantage of the addition of epinephrine.