TY - JOUR
T1 - Antepartum continuous epidural ropivacaine therapy reduces uterine artery vascular resistance in pre-eclampsia
T2 - A randomized, dose-ranging, placebo-controlled study
AU - Ginosar, Y.
AU - Nadjari, M.
AU - Hoffman, A.
AU - Firman, N.
AU - Davidson, E. M.
AU - Weiniger, C. F.
AU - Rosen, L.
AU - Weissman, C.
AU - Elchalal, U.
AU - Avidan, A.
AU - Golob, Y.
AU - Anteby, E. Y.
AU - Ezra, Y.
AU - Hochner-Celnikier, D.
AU - Mankuta, D. D.
AU - Yagel, S.
AU - Kleinberg, L.
AU - Haroutinian, S.
AU - Bar-Oz, B.
AU - Kaniel, H.
AU - Novick, N.
AU - Halpern, S. H.
PY - 2009/1/1
Y1 - 2009/1/1
N2 - Background: No therapy is currently available to improve the reduced uteroplacental blood flow (UPBF) that characterizes pre-eclampsia. We hypothesized that sympathectomy induced by epidural local anaesthesia reduces uterine vascular resistance (which is inversely correlated with UPBF) in pre-eclampsia. Methods: Ten pregnant women between 24 and 32 weeks of gestation with pre-eclampsia and uterine artery flow abnormalities were randomized to antepartum continuous epidural therapy (ACET) or control. ACET was initiated by a 5 day dose-ranging trial (ACET-1) of 0.04, 0.06, 0.08, and 0.1% ropivacaine and saline placebo, each at 10 ml h-1 for 24 h. Doses were randomized and double-blind. Doppler ultrasound indices of vascular resistance were assessed at baseline and after each 24 h dosing period in both uterine arteries. Subsequently, these ACET patients were administered 0.1% ropivacaine until delivery (ACET-2), with one additional randomized double-blind placebo day. Results: Five patients were randomized to ACET. In each patient, one uterine artery exhibited a dose-dependent reduction in vascular resistance (P=0.035), a response that returned to baseline following placebo (P<0.001). The contralateral uterine artery exhibited either increased vascular resistance or no change. In all cases, the uterine artery that responded to ACET had higher baseline resistance than its pair (P=0.043). Baseline right-left difference in resistance between paired uterine arteries was greatly diminished following ACET. Although ACET patients had a mean (sd) duration to delivery of 19 (9) days compared with control 2 (1) days (P=0.008), this should be interpreted with caution because of demographic differences between groups. Conclusions: ACET reduces uterine artery resistance in pre-eclampsia <32 weeks. Uteroplacental re-distribution is a novel observation and warrants further investigation.
AB - Background: No therapy is currently available to improve the reduced uteroplacental blood flow (UPBF) that characterizes pre-eclampsia. We hypothesized that sympathectomy induced by epidural local anaesthesia reduces uterine vascular resistance (which is inversely correlated with UPBF) in pre-eclampsia. Methods: Ten pregnant women between 24 and 32 weeks of gestation with pre-eclampsia and uterine artery flow abnormalities were randomized to antepartum continuous epidural therapy (ACET) or control. ACET was initiated by a 5 day dose-ranging trial (ACET-1) of 0.04, 0.06, 0.08, and 0.1% ropivacaine and saline placebo, each at 10 ml h-1 for 24 h. Doses were randomized and double-blind. Doppler ultrasound indices of vascular resistance were assessed at baseline and after each 24 h dosing period in both uterine arteries. Subsequently, these ACET patients were administered 0.1% ropivacaine until delivery (ACET-2), with one additional randomized double-blind placebo day. Results: Five patients were randomized to ACET. In each patient, one uterine artery exhibited a dose-dependent reduction in vascular resistance (P=0.035), a response that returned to baseline following placebo (P<0.001). The contralateral uterine artery exhibited either increased vascular resistance or no change. In all cases, the uterine artery that responded to ACET had higher baseline resistance than its pair (P=0.043). Baseline right-left difference in resistance between paired uterine arteries was greatly diminished following ACET. Although ACET patients had a mean (sd) duration to delivery of 19 (9) days compared with control 2 (1) days (P=0.008), this should be interpreted with caution because of demographic differences between groups. Conclusions: ACET reduces uterine artery resistance in pre-eclampsia <32 weeks. Uteroplacental re-distribution is a novel observation and warrants further investigation.
KW - Anaesthetic techniques, epidural
KW - Anaesthetics local, ropivacaine
KW - Complications, pre-eclampsia
KW - Pregnancy
UR - http://www.scopus.com/inward/record.url?scp=60249094013&partnerID=8YFLogxK
U2 - 10.1093/bja/aen402
DO - 10.1093/bja/aen402
M3 - Article
C2 - 19176534
AN - SCOPUS:60249094013
SN - 0007-0912
VL - 102
SP - 369
EP - 378
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 3
ER -
