Antepartum continuous epidural ropivacaine therapy reduces uterine artery vascular resistance in pre-eclampsia: A randomized, dose-ranging, placebo-controlled study

Y. Ginosar*, M. Nadjari, A. Hoffman, N. Firman, E. M. Davidson, C. F. Weiniger, L. Rosen, C. Weissman, U. Elchalal, A. Avidan, Y. Golob, E. Y. Anteby, Y. Ezra, D. Hochner-Celnikier, D. D. Mankuta, S. Yagel, L. Kleinberg, S. Haroutinian, B. Bar-Oz, H. KanielN. Novick, S. H. Halpern

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


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.

Original languageAmerican English
Pages (from-to)369-378
Number of pages10
JournalBritish Journal of Anaesthesia
Issue number3
StatePublished - Mar 2009

Bibliographical note

Funding Information:
Y.G. was supported by research grants from the International Anesthesia Research Society—Clinical Scholar Research Award (2003) and from the Women’s Health Fund of the Hadassah Medical Organization (2003).


  • Anaesthetic techniques, epidural
  • Anaesthetics local, ropivacaine
  • Complications, pre-eclampsia
  • Pregnancy


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