Comparison of Four Local Extradural Anaesthetic Solutions for Elective Caesarean Section †

Abstract

We have examined a combination of two local anaesthetics to see if the resultant solution is superior to the agents individually. This study shows that a mixture of bupivacaine and lignocaine provided an excellent alternative to bupivacaine alone, and was superior to 2% lignocaine with adrenaline for elective Caesarean section. By reducing the dose of bupivacaine used, the combination may reduce the risk of cardiotoxicity.

Extending low‐dose epidural analgesia for emergency Caesarean sectionA comparison of three solutions

“…The addition of adrenaline to epidural bupivacaine 0.5% has been shown to improve quality of block for elective Caesarean section but not when an existing epidural is extended for emergency Caesarean section [1]. Howell et al did not demonstrate any reduction in onset time when adrenaline with bupivacaine was used for elective Caesarean section compared with using bupivacaine alone [3]. One of the reasons adrenaline is added to local anaesthetic solutions is the reduction in local anaesthetic plasma levels that it produces, and consequent increased safety margin; however, it has been demonstrated that epidural adrenaline does not usefully reduce systemic absorption of 0.5% bupivacine in emergency Caesarean section [1].…”

“…There are few published data in this area, but using figures from previous related work [2,3] we calculated our study would have 80% power to detect a 30% difference in the time taken to extend an existing low-dose epidural block to T 4 . In fact, we found much larger variability in onset times than that reported in other studies, possibly because we used lowdose bolus top-ups in labour instead of low-dose infusions or more concentrated solutions as in other studies.…”

“…Pre-existing epidurals using 0.25-0.5% bupivacaine may be safely extended for Caesarean section with slow boluses of 20 ml 0.5% bupivacaine [1] or 20 ml 2% lignocaine with 1 : 200 000 adrenaline [2]. Because a 50 : 50 mixture of 0.5% bupivacaine and 2% lignocaine with 1 : 200 000 adrenaline may be superior to 2% lignocaine for elective Caesarean section [3], this mixture is often used to extend low-dose epidural analgesia for emergency Caesarean section. Dickson and Jenkins found that 10 ml of 0.5% bupivacaine alone was inadequate for Caesarean section in seven out of 18 patients when used to extend epidural blockade provided by 0.1% bupivacaine infusion [4].…”

Extending low‐dose epidural analgesia in labour for emergency Caesarean section – a comparison of levobupivacaine with or without fentanyl*

“…The optimal technique for extending epidural analgesia in labour to a block suitable for Caesarean section remains ................................................................................................................................................................................................................... Ó 2007 The Authors uncertain, with the findings of studies of elective cases apparently non-transferable to the emergency situation [1,2,4,5,16]. As in previous studies [1,2,14] we found that time to onset of surgical anaesthesia was unrelated to patients' height or weight, the duration of epidural analgesia, the total dose of bupivacaine given during labour, the time since the last top-up, or the level of preexisting block.…”

Ropivacaína, articaína ou combinação de ropivacaína e articaína em anestesia peridural para cesariana: estudo randomizado, prospectivo e duplo-cego

“…In order to avail these properties, adjuvants have been used with local anesthetics [4][5][6][7][8][9] or local anesthetics with different properties have been combined 10 . Ropivacaine, due to its weaker motor block effect, has become popular for obstetric anesthesia and analgesia in the last two decades.…”