Epinephrine as epidural adjuvant for postoperative analgesia.

What is it about?

Epinephrine has been combined with neuraxial and peripheral local anesthetics since Heinrich Braun first experimented with its use in the early 1900s. A century of use attests to the general safety of adjuvant epinephrine, yet we have an only modest understanding of its intended effects, which include prolonging block duration, reducing plasma concentrations of local anesthetics, reducing surgical bleeding and intensifying anesthesia and analgesia.The long held belief that epinephrine exerts most of these effects, including any associated complications, by causing vasoconstriction is doubtlessly too simplistic and has been recently challenged.The main part of this chapter will, therefore, focus on the advantages and disadvantages of epinephrine in epidural analgesia and on optimizing postoperative analgesia by adding epinephrine and/or fentanyl to an epidural mixture with dilute bupivacaine or ropivacaine​.

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