title: Extension of epidural blockade in labour for emergency Caesarean section using 2% lidocaine with epinephrine and fentanyl, with or without alkalinisation.
abstract: 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 microg, 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.
authors.affiliation: Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
authors.forename: D T
authors.initials: DT
authors.lastname: Lam
authors.forename: W D
authors.initials: WD
authors.lastname: Ngan Kee
authors.forename: K S
authors.initials: KS
authors.lastname: Khaw
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods; D016362:Analgesia, Obstetrical / Q000379:methods; D000773:Anesthesia, Obstetrical / Q000379:methods; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D002585:Cesarean Section / Q000379:methods*; D004630:Emergencies; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007268:Injections, Epidural; D008012:Lidocaine / Q000008:administration & dosage*; D009407:Nerve Block / Q000379:methods; D011247:Pregnancy; D017693:Sodium Bicarbonate / Q000008:administration & dosage; D012965:Sodium Chloride / Q000008:administration & dosage; D013566:Sympathomimetics / Q000008:administration & dosage*
chemical_list: D019162:Anesthetics, Combined; D013566:Sympathomimetics; D012965:Sodium Chloride; D017693:Sodium Bicarbonate; D008012:Lidocaine; D005283:Fentanyl; D004837:Epinephrine