Public Defence: Felix Haidl Felix Haidl at Institute of Clinical Medicine will be defending the thesis “Labor epidural analgesia: the role of adrenaline” for the degree of PhD (Philosophiae Doctor).

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Photo: Sjur Hansen Tveit.

An electronic copy of the thesis may be ordered from the faculty up to 2 days prior to the public defence. Inquiries regarding the thesis after the public defence must be addressed to the candidate.

Trial Lecture – time and place

See Trial Lecture.

Adjudication committee

  • First opponent: Associate Professor, Senior Consultant Kim Ekelund, Juliane Marie Center, Copenhagen University Hospital Rigshospitalet
  • Second opponent: Senior Consultant Johanna Sarvela, Jorvi Hospital, Helsinki University Central Hospital
  • Third member and chair of the evaluation committee: Professor Kjetil Sunde, University of Oslo

Chair of the Defence

Professor Henrik Huitfeldt, University of Oslo

Principal Supervisor

Professor Vegard Dahl, Faculty of Medicine, University of Oslo


Most women experience severe pain during labor. Epidural analgesia is considered the gold standard of labor analgesia and is achieved by infusing local anesthetic and opioids (e.g. fentanyl) in to the epidural space. To further enhance analgesia efficacy, adjuvants such as adrenaline may be used, and different modes of administration (e.g. continuous infusions (CEI), patient controlled boluses or programmed intermittent boluses (PIEB)) has been studied.

The aim of this thesis was to investigate different aspects of adrenaline use in labor epidural analgesia, specifically if the concentration of fentanyl in maternal and fetal umbilical plasma was lowered with the use of adrenaline, if the maternal hemodynamics are affected by the use of epidural adrenaline, and finally if the use of programmed intermittent boluses are more efficacious than a continuous infusion in maintaining labor analgesia when adrenaline is used. These hypotheses were investigated in two randomized clinical trials.

We found lower plasma concentrations of fentanyl in maternal plasma during the first two hours of treatment, but no differences at delivery or differences in umbilical plasma.

We found no significant differences in maternal hemodynamics during the first 30 min of treatment.

We found no differences in treatment efficacy when comparing PIEB to CEI.

Overall, it is not possible to give a final conclusion on the use of adrenaline in labor epidural analgesia, but the data from our studies does not give grounds for a strong recommendation of its use in clinical practice.


Additional information

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Published Sep. 9, 2022 12:59 PM - Last modified Sep. 22, 2022 1:44 PM