Preservative-free bicarbonate for epidural top-up

Preservative-free bicarbonate for epidural top-up1

“…Drs Halder et al. believe that a lidocaine‐adrenaline‐bicarbonate mixture is the optimum for epidural top‐up for emergency caesarean section, but express concerns over the potential for neurotoxicity if preservative‐containing bicarbonate is used.…”

“…It is sometimes difficult to make a change in practice if that introduces a new risk, as described by Halder et al. . We have been using preservative‐containing bicarbonate and adrenaline for over 15 years, and have not therefore been presented with making a novel risk‐benefit analysis.…”

Preservative-free bicarbonate for epidural top-ups

“…I read with interest the article by Abdulatif et al [1] on the use of intra-operative magnesium to prevent postoperative agitation in children aged 4-7 years, undergoing adenotonsillectomy. It suggests an interesting and novel way to manage a common, and often underreported, problem.…”

Preservative-free bicarbonate for epidural top-up3

“…Preservative-free bicarbonate for epidural top-up 2 We read the letter by Halder et al [1] with interest and would like to share our unit's experience. We currently deliver over 6500 women per year in our tertiary referral teaching hospital.…”

“…Experience thus far suggests an onset time comparable with our preferred mixture (lidocaine, bicarbonate and adrenaline), but motor block is reduced in intensity and onset is delayed considerably, and patients complain more often of an uncomfortable 'tugging' sensation. Preservative-free bicarbonate for epidural top-up 3 We read with great interest the recent letter by Halder et al [1] regarding the current shortage of preservative-free bicarbonate, used in epidural top-up solutions. Our unit also has a long-standing 'quick-mix' epidural top-up formulation consisting of 2% lidocaine, 8.4% bicarbonate and 1:1000 adrenaline.…”