Comparison of pH-Adjusted Lidocaine Solutions for Epidural Anesthesia

DiFazio, Cosmo A.; Carron, Harold; Grosslight, K. R.; Moscicki, Jeffrey C.; Bolding, W. R.; Johns, Roger A.

doi:10.1213/00000539-198607000-00010

Cited by 155 publications

(26 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This mixture has been described in the literature for both elective [8][9][10][11] and emergency [12][13][14] Caesarean section, and anecdotal contact with non-UK anaesthetists suggests that this mixture is also widely used around the world. However, although addition of bicarbonate to lidocaine results in rapid onset of anaesthesia for elective Caesarean section [11] and speeds the onset of lidocaine when used for extending labour analgesia for emergency Caesarean section [14], we are unaware of any studies of topping up an epidural for emergencies that compare lidocainebicarbonate mixtures with other agents available in the UK, although lidocaine without bicarbonate has been found to have no advantage over bupivacaine in this situation [3,15].…”

mentioning

confidence: 99%

Epidural lidocaine‐bicarbonate‐adrenaline vs levobupivacaine for emergency Caesarean section: a randomised controlled trial*

Allam¹,

Malhotra

Hemingway³

et al. 2008

Anaesthesia

109

View full text Add to dashboard Cite

SummaryEpidural 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 lidocainebicarbonate-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. When extending epidural analgesia in labour for emergency Caesarean section, the most appropriate choice of local anaesthetic for achieving rapid and reliable epidural anaesthesia remains unclear. A recent survey of leading UK obstetric anaesthetists [1] found that 13 combinations of local anaesthetics and adjuncts are used in this situation, with 2% lidocaine (alone or in combination) used by 40% of respondents and 0.5% levobupivacaine or bupivacaine used by 72% of respondents (some respondents using more than one in their practice). In our unit, levobupivacaine is the standard agent used in this situation and was adopted as a result of previous studies that showed no consistent advantage of alternatives [2][3][4], and because of the superior safety profile of levobupivacaine compared with bupivacaine [5,6]. Use of levobupivacaine has recently been recommended as best practice when extending epidural analgesia for emergency Caesarean section [7].We have found that trainees rotating to our unit often report the use of a lidocaine-bicarbonate-adrenaline mixture in other units when a faster onset of block is required, for example when there is fetal compromise.

show abstract

mentioning

confidence: 99%

Epidural lidocaine‐bicarbonate‐adrenaline vs levobupivacaine for emergency Caesarean section: a randomised controlled trial*

Allam¹,

Malhotra

Hemingway³

et al. 2008

Anaesthesia

109

View full text Add to dashboard Cite

show abstract

“…Difazio era/. suggested that improvement in onset time was directly related to the degree of change in pH [8]. While several studies involving a significant change in pH have shown positive results [2, 5, 71, one has produced no effect [3].…”

Section: Discussionmentioning

confidence: 99%

The effect of alkalinisation of lignocaine on axillary brachial plexus anaesthesia

Gormley¹,

Hill²,

Murray³

et al. 1996

Anaesthesia

View full text Add to dashboard Cite

Lisburn R o a d , Belfast, N o r t h e r n Ireland. Prolonged latency following brachial plexus anaesthesia presents a potential problem in the busy clinical setting. Efforts to improve onset time have centred on the choice and modification of local anaesthetic solutions. Summary Alkalinisation of local anaesthetic drugs is a controcersialAlkalinisation has been shown to improve neural blockade in animal models [I]. and research involving alkalinisation of different local anaesthetic solutions has been undertaken in various clinical settings in man: brachial plexus [2-71, epidural anaesthesia [%lo], and various others [I I , 121. The results produced have been conflicting, ranging from no effect to improvement in both onset and duration of anaesthesia. Although the pharmacology is well understood, the topic remains one of controversy. Technique, agent specificity, the addition of adrenaline, and the degree of change in pH have been suggested as possible explanations [ 5 , 71.The choice of local anaesthetic agent is also important in determining the latency of neural blockade. Traditionally, lignocaine has been used during brachial plexus anaesthesia to produce a relatively fast onset time. However, the duration of anaesthesia is often less than with other local anaesthetic agents. This study has investigated the effect of alkalinisation on latency, quality and duration of anaesthesia. MethodsApproval for the study protocol was granted by the Regional Ethics Committee. Forty-two patients conforming to ASA grades 1 and 2 were studied with their written informed consent. Patients were scheduled for elective or emergency upper limb surgery, aged between 18 and 70 years and with weights between 50 and 100 kg. Those with a history of epilepsy, renal or hepatic dysfunction, or who were receiving anticoagulant drugs were not studied.Patient characteristics noted included age, gender and weight. The nature, and the duration of surgery were also recorded. No premedication was given. Patient monitoring included continuous electrocardiograph, heart rate and peripheral oxygen saturation. Non-invasive arterial blood pressure

show abstract

“…Bupivacaine 0.5%, lidocaine 2%, and chloroprocaine 2% were chosen because these were the local anaesthetics and concentrations previously reported to exhibit a hastened onset following alkalinization with NaHCO 3 in parturients. [1][2][3] Five boules of each local anaesthetic were studied and each specific local anaesthetic had the same lot number. Each local anaesthetic solution was alkalinized with NaHCO 3 (8.4%) in a preliminary study at our institution to increase the pH to the maximum value that could be obtained without causing precipitation.…”

Section: Methodsmentioning

confidence: 99%

The air-liquid interface and the pH and PCO2 of alkalinized local anaesthetic solutions

1992

View full text Add to dashboard Cite

Comparison of pH-Adjusted Lidocaine Solutions for Epidural Anesthesia

Cited by 155 publications

References 0 publications

Epidural lidocaine‐bicarbonate‐adrenaline vs levobupivacaine for emergency Caesarean section: a randomised controlled trial*

Epidural lidocaine‐bicarbonate‐adrenaline vs levobupivacaine for emergency Caesarean section: a randomised controlled trial*

The effect of alkalinisation of lignocaine on axillary brachial plexus anaesthesia

The air-liquid interface and the pH and PCO2 of alkalinized local anaesthetic solutions

Contact Info

Product

Resources

About