{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:10:37Z","timestamp":1787022637490,"version":"build-2736575974"},"reference-count":31,"publisher":"Walter de Gruyter GmbH","issue":"4","license":[{"start":{"date-parts":[[2021,5,10]],"date-time":"2021-05-10T00:00:00Z","timestamp":1620604800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,10,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_sjpain-2020-0176_s_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      Labour is one of the most painful experiences in a woman\u2019s life. Epidural analgesia using low-concentration local anaesthetics and lipophilic opioids is the gold standard for pain relief during labour. Pregnancy in general, particularly labour, is associated with changes in maternal haemodynamic variables, such as cardiac output and heart rate, which increase and peak during uterine contractions. Adrenaline is added to labour epidural solutions to enhance efficacy by stimulating the \u03b12-adrenoreceptor. The minimal effective concentration of adrenaline was found to be 2\u00a0\u03bcg\u00a0mL\n                      <jats:sup>\u22121<\/jats:sup>\n                      for postoperative analgesia. The addition of adrenaline may also produce vasoconstriction, limiting the absorption of fentanyl into the systemic circulation, thereby reducing foetal exposure. However, adrenaline may influence the haemodynamic fluctuations, possibly adding to the strain on the circulatory system. The aim of this study was to compare the haemodynamic changes after application of labour epidural analgesia with or without adrenaline 2\u00a0\u03bcg\u00a0mL\n                      <jats:sup>\u22121<\/jats:sup>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_sjpain-2020-0176_s_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a secondary analysis of a single-centre, randomised double-blind trial. Forty-one nulliparous women in labour requesting epidural analgesia were randomised to receive epidural solution of bupivacaine 1\u00a0mg\u00a0mL\n                      <jats:sup>\u22121<\/jats:sup>\n                      , fentanyl 2\u00a0\u03bcg\u00a0mL\n                      <jats:sup>\u22121<\/jats:sup>\n                      with or without adrenaline 2\u00a0\u03bcg\u00a0mL\n                      <jats:sup>\u22121<\/jats:sup>\n                      . The participants were monitored using a Nexfin CC continuous non-invasive blood pressure and cardiac output monitor. The primary outcomes were changes in peak systolic blood pressure and cardiac output during uterine contraction within 30\u00a0min after epidural activation. The effect of adrenaline was tested statistically using a linear mixed-effects model of the outcome variables\u2019 dependency on time, adrenaline, and their interaction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_sjpain-2020-0176_s_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After excluding three patients due to poor data quality and two due to a malfunctioning epidural catheter, 36 patients (18 in each group) were analysed. The addition of adrenaline to the solution had no significant effect on the temporal changes in peak systolic blood pressure (p\n                      <jats:italic>=<\/jats:italic>\n                      0.26), peak cardiac output (0.84), or heart rate (p\n                      <jats:italic>=<\/jats:italic>\n                      0.91). Furthermore, no significant temporal changes in maternal haemodynamics (peak systolic blood pressure, p=0.54, peak cardiac output, p=0.59, or heart rate p=0.55) were associated with epidural analgesia during 30\u00a0min after epidural activation in both groups despite good analgesia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_sjpain-2020-0176_s_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The addition of 2\u00a0\u03bcg\u00a0mL\n                      <jats:sup>\u22121<\/jats:sup>\n                      adrenaline to the epidural solution is not likely to change maternal haemodynamics during labour.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/sjpain-2020-0176","type":"journal-article","created":{"date-parts":[[2021,5,11]],"date-time":"2021-05-11T20:01:21Z","timestamp":1620763281000},"page":"680-687","source":"Crossref","is-referenced-by-count":2,"title":["Maternal haemodynamics during labour epidural analgesia with and without adrenaline"],"prefix":"10.1515","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6372-8117","authenticated-orcid":false,"given":"Felix","family":"Haidl","sequence":"first","affiliation":[{"name":"Department of Anaesthesia , Akershus University Hospital , L\u00f8renskog , Norway"},{"name":"Institute of Clinical Medicine, University of Oslo , Oslo , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Tronstad","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine, University of Oslo , Oslo , Norway"},{"name":"Department of Clinical and Biomedical Engineering , Oslo University Hospital , Oslo , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leiv Arne","family":"Rosseland","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine, University of Oslo , Oslo , Norway"},{"name":"Department of Research and Development, Division of Emergencies and Critical Care , Oslo University Hospital , Oslo , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vegard","family":"Dahl","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia , Akershus University Hospital , L\u00f8renskog , Norway"},{"name":"Institute of Clinical Medicine, University of Oslo , Oslo , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2021,5,10]]},"reference":[{"key":"2025120910043533106_j_sjpain-2020-0176_ref_001","doi-asserted-by":"crossref","unstructured":"Capeless, EL, Clapp, JF. Cardiovascular changes in early phase of pregnancy. Am J Obstet Gynecol 1989;161:1449\u201353. https:\/\/doi.org\/10.1016\/0002-9378(89)90902-2.","DOI":"10.1016\/0002-9378(89)90902-2"},{"key":"2025120910043533106_j_sjpain-2020-0176_ref_002","doi-asserted-by":"crossref","unstructured":"Grindheim, G, Estensen, ME, Langesaeter, E, Rosseland, LA, Toska, K. Changes in blood pressure during healthy pregnancy: a longitudinal cohort study. J Hypertens 2012;30:342\u201350. https:\/\/doi.org\/10.1097\/hjh.0b013e32834f0b1c.","DOI":"10.1097\/HJH.0b013e32834f0b1c"},{"key":"2025120910043533106_j_sjpain-2020-0176_ref_003","doi-asserted-by":"crossref","unstructured":"Robson, SC, Dunlop, W, Boys, RJ, Hunter, S. Cardiac output during labour. 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