EPIDURAL LIDOCAINE FOR CESAREAN DELIVERY OF THE DISTRESSED FETUS

Lidocaine with epinephrine and sodium bicarbonate has a rapid onset of action, We therefore wished to compare its use with that of chloropro caine for urgent cesarean delivery. Thirty parturients for cesarean se ction under epidural anesthesia were divided into three groups. Group 1 required elective cesarean section and served as the control group f or neonatal lidocaine levels. Groups 2 and 3 had been receiving epidur al infusions of 0.125% bupivacaine with epinephrine 1:400000 and requi red urgent cesarean section. They were randomized to receive either 1. 5% lidocaine with epinephrine or 3% chloroprocaine, both with sodium b icarbonate 2 mi in a total volume of 25 mi. All patients had adequate anesthesia and none required supplementation. The time from completion of injection to the achievement of a T4 sensory level was significant ly shorter in the chloroprocaine group (3.1 vs. 4.4 min). There were n o differences in Apgar scores or Neurologic and Adaptive Capacity Scor es between the lidocaine and chloroprocaine groups. Lidocaine was dete ctable in maternal serum from four of the urgent cases and all of the elective cases. It was detectable in five neonates from the elective g roup but none from the emergency group. In parturients with preexistin g epidural catheters and a baseline epidural infusion to maintain a T1 0 sensory level, chloroprocaine is faster in onset than lidocaine, but the difference in this study was only 1.3 min, and both agents provid ed excellent anesthesia.