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Extension of epidural blockade in labour for emergency Caesarean section using 2% lidocaine with epinephrine and fentanyl, with or without alkalinisation*
Author(s) -
Lam D. T. C.,
Ngan Kee W. D.,
Khaw K. S.
Publication year - 2001
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1046/j.1365-2044.2001.02058-4.x
Subject(s) - medicine , lidocaine , anesthesia , epinephrine , caesarean section , fentanyl , saline , sodium bicarbonate , pregnancy , surgery , chemistry , biology , genetics
In a randomised, double‐blind study, we investigated rapid extension of epidural analgesia to surgical anaesthesia for emergency Caesarean section. Parturients receiving epidural analgesia in labour who subsequently required Caesarean section were given a test dose of 3 ml lidocaine 2% with epinephrine 1 : 200 000, followed 3 min later by 12 ml lidocaine 2% with epinephrine 1 : 200 000 and fentanyl 75 µ g, to which was added 1.2 ml sodium bicarbonate 8.4% (bicarbonate group; n = 20) or saline (saline group; n = 20). Mean (SD [range]) time to surgical anaesthesia was less in the bicarbonate group (5.2 (1.5) [2–8] min) than the saline group (9.7 (1.6) [6–12] min; mean difference 4.5 min (95% CI 3.5–5.5) min; p < 0.001). Maternal side‐effects and neonatal outcome were similar between groups. We conclude that pH‐adjusted lidocaine 2% with epinephrine and fentanyl is effective for rapidly establishing surgical anaesthesia in patients with a functioning epidural catheter for labour who require emergency Caesarean section.