Possible Interaction: Epinephrine and Fentanyl

“We conclude that epinephrine improves the pain relief and reduces the side effects of a thoracic epidural infusion of ropivacaine and fentanyl after major thoracic or upper abdominal surgery.”

“We have shown that epinephrine markedly improves the analgesic effect of a thoracic epidural infusion of bupivacaine and fentanyl.”

“Our data also show that the total required dose of epidural, but not IV, fentanyl is reduced by very small dose epidural bupivacaine and epinephrine (Group I versus Group IV, P < 0.02 and Group II vs Group III, not significant).”

“The authors conclude that the addition of epinephrine 3.33 micrograms/ml significantly increases the duration of analgesia obtained from 0.25% bupivacaine with 5 micrograms/ml fentanyl.”

“The results suggest that both fentanyl and epinephrine improve intraoperative analgesia.”

“In general the incidences of side effects were related to the concentrations of fentanyl used and apart from itching, the incidences of these side effects were reduced by the addition of adrenaline.”

“The total dose of rescue fentanyl was significantly lower in the EPI group (seven subjects needed 16 doses) than in the IV group [12 subjects needed 71 doses (P=0.001)].”

“Co-administering adrenaline with fentanyl will slow the systemic absorption and the supraspinal effects of fentanyl.”

“Thus, adrenaline has a pharmacodynamic synergism with fentanyl and bupivacaine when the three drugs are co-administered epidurally: They act by three different analgesic mechanisms at the dorsal horn level, in low concentrations from the small doses reaching the spinal cord from the epidural space.”

“The addition of epinephrine to solutions containing fentanyl and bupivacaine for epidural infusion has been shown to improve the quality of analgesia.”

“The addition of 25 micrograms epinephrine to the fentanyl (100 micrograms) did not potentiate the speed of onset but did significantly prolong the duration of action of the second dose.”

“The results indicate a clinical advantage of prolonging the duration of action of fentanyl for post-Caesarean Section analgesia with the addition of epinephrine , but the cumbersome and time-consuming nature of a double-bolus technique limits its clinical value.”

“ Epinephrine had no effect on the terminal elimination half-life of morphine in the epidural space, but it decreased that of fentanyl and sufentanil.”