• D P McGlade, P M Murphy, M J Davies, D A Scott, and B S Silbert.
• Department of Anesthesia, St. Vincent's Hospital, Melbourne, Victoria, Australia.
• J. Cardiothorac. Vasc. Anesth. 1996 Aug 1; 10 (5): 593-7.

ObjectivesThis study was designed to investigate whether the addition of epinephrine as a vasoconstrictor additive to local anesthetic affects the hemodynamic profile after cervical plexus block in patients presenting for carotid endarterectomy.DesignA prospective, double-blind, randomized trial.SettingA university hospital.ParticipantsForty patients scheduled for carotid endarterectomy under regional anesthesia (cervical plexus block).InterventionsPatients were randomized to one of two groups. Group P (20 patients) received plain bupivacaine; group E (20 patients) received bupivacaine with epinephrine, 5 micrograms/mL. All patients received 2 mg/kg of bupivacaine, and group E received 2 micrograms/kg of epinephrine. The electrocardiogram and intra-arterial blood pressure were monitored continuously, and recordings of heart rate and blood pressure were recorded at predetermined intervals from before the block until the skin incision.ResultsAfter the block, group E developed a sustained increase in heart rate of approximately 15% (p < 0.01), whereas group P showed no change. Systolic blood pressure increased significantly with time over the study period in both groups (p < 0.01). Diastolic blood pressure increased significantly in group P (p < 0.01) but not in group E.ConclusionsConcerning cervical plexus block with bupivacaine, the use of epinephrine is associated with an increase in heart rate consistent with a beta-adrenergic effect from systemic absorption of the epinephrine. An increase in systolic blood pressure independent of the use of epinephrine also occurs, but epinephrine appears to mitigate against an increase in diastolic blood pressure.

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