Effect of Increasing Amounts of Epinephrine during Isobaric Bupivacaine Spinal Anesthesia in Elderly Patients

The effects of adding epinephrine to isobaric bupivacaine spinal anesthesia were investigated in 96 ASA class II-III patients aged 75 yr or more scheduled for lower extremity surgery. The subjects were randomly allocated into six groups. All patients received 15 mg bupivacaine plain solution in 4 ml, in the horizontal position. Patients in group 1 received bupivacaine plus 1 ml normal saline; patients in other groups received bupivacaine plus increasing dosages of epinephrine: 0.1 mg (group 2), 0.2 mg (group 3), 0.3 mg (group 4), 0.4 mg (group 5), 0.5 mg (group 6). The segmental level of sensory loss was tested using forceps. The time required for maximal spread of the sensory blockade was significantly 50% greater in group 5 than in group 1. No difference was observed, however, between mean highest levels. Addition of 0.2 mg epinephrine prolonged by a significant 25% regression time to L-2 level. Addition of 0.3 and 0.4 mg epinephrine significantly prolonged two-segment regression time by 36 and 53%, respectively, and regression to L-2 level by 29 and 44%, respectively. Addition of 0.5 mg epinephrine did not result in further prolongation of anesthesia. Motor blockade was also increased by addition of epinephrine. It is concluded that addition of 0.3 mg epinephrine may be useful to increase duration of isobaric bupivacaine spinal anesthesia.