Rr. Gaiser et al., EPIDURAL LIDOCAINE FOR CESAREAN DELIVERY OF THE DISTRESSED FETUS, International journal of obstetric anesthesia, 7(1), 1998, pp. 27-31
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.