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Epidural lidocaine‐bicarbonate‐adrenaline vs levobupivacaine for emergency Caesarean section: a randomised controlled trial *
Author(s) -
Allam J.,
Malhotra S.,
Hemingway C.,
Yentis S. M.
Publication year - 2008
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.2007.05342.x
Subject(s) - levobupivacaine , medicine , lidocaine , caesarean section , anesthesia , sedation , epinephrine , visual analogue scale , surgery , pregnancy , analgesic , biology , genetics
Summary Epidural mixtures containing lidocaine with or without additives are commonly used to convert epidural analgesia in labour to anaesthesia for emergency Caesarean section, but direct comparisons with alternative, single agents in this situation are few. In a prospective double‐blinded trial, we compared a freshly prepared lidocaine‐bicarbonate‐adrenaline mixture (final concentrations 1.8%, 0.76% and 1 : 200,000, respectively) with our standard agent, levobupivacaine 0.5%, for extending epidural blockade for emergency Caesarean section. Using a sequential analysis technique, with data analysed in blocks of 40, women receiving epidural analgesia in labour who required top‐up for Caesarean section were randomly assigned to receive 20 ml of epidural solution over 3 min. The first analysis ( n = 40) indicated that the study should be stopped, as significant differences were found in our primary outcome data. Median (IQR [range]) times to reach a block to touch to T5 and cold to T4 were, respectively, 7 (6–9 [5–17]) min and 7 (5–8 [4–17]) min for lidocaine‐bicarbonate‐adrenaline, and 14 (10 −17 [9–31]) min and 11 (9–14 [6–30]) min for levobupivacaine (p = 0.00004 and 0.001, respectively). Pre‐ and intra‐operative supplementation/pain, maternal side‐effects and neonatal outcomes (excluding five women who underwent instrumental delivery) were similar between the groups. Intra‐operative maternal sedation (scored by the mother on a 10‐point scale) was greater with lidocaine‐bicarbonate‐adrenaline (4.5 (3–8 [1–9])) than with levobupivacaine (3 (1–4 [1–7])), but not significantly so (p = 0.07). We conclude that epidural lidocaine‐bicarbonate‐adrenaline halves the onset time when extending epidural analgesia for Caesarean section although there is a possibility of increased maternal sedation.