Influence of Venous Return on Baroreflex Control of Heart Rate during Lumbar Epidural Anesthesia in Humans

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Abstract
The role of variation of venous return on baroreflex control of heart rate during lumbar epidural anesthesia was investigated in 12 unpremedicated patients. Group 1 patients (n = 6) received 8 ml of 0.5% plain bupivacaine in the epidural space (L3-4) (mean upper level of analgesia at T10). Group 2 patients (n = 6) received 8 ml of saline at the same level in the epidural space. Following the epidural injection, phenylephrine (PHE) and nitroglycerin (NTG) were employed to alter the stimulation of baroreceptor sites before and during application of lower body positive pressure (LBPP). Plasma bupivacaine, catecholamines, renin activity, and vasopressin were assayed. In contrast to saline, epidural bupivacaine induced a decrease in systolic arterial and right atrial pressures (-11 .+-. 4 and -3.2 .+-. 0.7 mm Hg, respectively, mean .+-. SEM) without change in heart rate, an increase in baroreflex slopes during PHE and NTG injections (+5.9 .+-. 1.6 ms/mm Hg and +2.8 .+-. 0.9 ms/mm Hg, respectively), and a decrease in plasma norephinephrine (-248 .+-. 89 pg/ml). The application of LBPP restored hemodynamic and reflex variables to preepidural analgesia values, whereas plasma catecholamines decreased further. Plasma renin activity and vasopressin were not modified at any time in either groups. This study indicates that lumbar epidural anesthesia enhances cardiac vagal tone mainly through a decrease in venous return.