ORIGINAL ARTICLE Local infiltration of epinephrine-containing lidocaine with bicarbonate reduces superficial bleeding and pain during labor epidural catheter insertion: a randomized trial B. Carvalho, A. Fuller, C. Brummel, S. E. Cohen Department of Anesthesia, Stanford University School of Medicine, Stanford, California, USA Background: Superficial bleeding after labor epidural catheter placement is a common phenomenon. In addition to delaying securing the epidural catheter, it may loosen the adhesive catheter dressing. The primary aim of this study was to determine whether skin infiltration with epinephrine-containing rather than plain lidocaine reduces superficial bleeding after catheter placement. Secondary objectives were to determine whether adding epinephrine and/or sodium bicarbonate affected infiltration pain. Methods: After institutional review board approval and informed consent, 80 healthy women receiving epidural analgesia during labor were randomly assigned in a double-blind manner to four local anesthetic mixtures (n = 20 in each group): group L: lidocaine 1.5%, group LB: lidocaine 1.5% with 8.4% sodium bicarbonate, group LE: lido- caine 1.5% with epinephrine 1:200 000, and group LEB: lidocaine 1.5% with epinephrine 1:200 000 and 8.4% sodium bicarbonate. Clinical endpoints included the amount of superficial bleeding at the catheter site, pain during local anes- thetic infiltration and epidural catheter movement during labor. Results: Demographic data were similar among the groups. The addition of epinephrine to lidocaine significantly reduced superficial bleeding. Solutions containing epinephrine were well tolerated and caused no cardiovascular dis- turbances. The addition of epinephrine did not increase pain, while bicarbonate reduced it [verbal score (scale 0-10) 3.6 € 2.2 vs. 2.6 € 1.8; P = 0.04]. There were no differences in epidural catheter movement among the groups; no catheters became displaced during labor. Conclusion: Local infiltration of epinephrine-containing lidocaine before epidural catheter insertion reduces super- ficial bleeding and the addition of bicarbonate decreases pain during skin infiltration. Ó 2006 Elsevier Ltd. All rights reserved. Keywords: Local anesthesia; Epinephrine; Bicarbonate; Labor epidural INTRODUCTION Superficial bleeding during epidural catheter insertion is a common clinical phenomenon. In a number of surgical settings, epinephrine-containing local anesthetic solu- tions reduce perioperative bleeding from surgical wound sites. 1–6 No previous study has determined whether add- ing epinephrine to the lidocaine used for local infiltra- tion reduces the amount of superficial bleeding at the site of epidural needle insertion. The primary objective International Journal of Obstetric Anesthesia (2007) 16, 116–121 Ó 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.ijoa.2006.09.006 Accepted September 2006 The study was conducted at Lucile Packard Children’s Hospital and Stanford University School of Medicine, Stanford, California and funded internally by the Department of Anesthesia, Stanford University School of Medicine. Findings from this study were presented at the 37th Annual Meeting of the Society for Obstetric Anesthesia and Perinatology (SOAP), May 2005, Palm Springs, California. B. Carvalho MB, BCh, FRCA, and S.E. Cohen MB, Ch.B, FRCA, Department of Anesthesia, Stanford University School of Medicine, Stanford, California; A. Fuller MD, Current affiliation: Private practice, Northern Colorado Anesthesia Professional Consultants, Fort Collins, Colorado; C. Brummel MD, Current affiliation: Private practice, Colorado Permanente Medical Group, Denver, Colorado, USA. Correspondence to: Brendan Carvalho MB, BCh, FRCA, Department of Anesthesia, H3580, Stanford University School of Medicine, Stanford, California 94305, USA. Tel.: +1 650 861 8607; fax: +1 650 725 8544. E-mail: bcarvalho@stanford.edu. 116