The condition of newborns after the conversion of epidural analgesia to anesthesia during cesarean section: a prospective randomized study

Abstract

INTRODUCTION: When performing epidural analgesia in childbirth, if surgical delivery is necessary, the question arises about the choice of further tactics of regional anesthesia. The article discusses the peculiarities of the effect of local anesthetics on the condition of a newborn during the conversion of epidural analgesia into anesthesia when caesarean section is necessary, depending on the local anesthetic used. OBJECTIVE: To assess the condition of a newborn baby during the conversion of epidural analgesia in childbirth through the natural birth canal into anesthesia during cesarean section, depending on the local anesthetic used. MATERIALS AND METHODS: A prospective randomized study of 143 children born to mothers who underwent the conversion of epidural analgesia into anesthesia for operative delivery by caesarean section was conducted. Depending on the local anesthetic used, the patients were divided into three groups, in the first group 20.0 ml of 2 % lidocaine in combination with 0.1 mg of epinephrine was injected into the epidural space, in the second group — 20.0 ml of 0.5 % bupivacaine, in the third — 20.0 ml of 0.75 % ropivacaine. The assessment of the condition of newborns was carried out on the Apgar scale at the 1st and 5th minutes of life and on the NACS scale in the first 15 minutes, 2, 24 and 72 hours after birth. RESULTS: The assessment of newborns on the Apgar scale, regardless of the local anesthetic used during epidural anesthesia at the first and fifth minutes, corresponded to 7 or more points (p > 0.05). The neuropsychiatric state of newborns when assessed on the NACS scale did not differ statistically significantly in all groups and at all stages of the study. Within each group, between the study stages, the average values of the NACS scores increased statistically significantly compared to the previous one. CONCLUSIONS: The conversion of epidural analgesia in childbirth through the natural birth canal into anesthesia during cesarean section is safe for the fetus and newborn when using 20.0 ml of 2 % lidocaine in combination with 0.1 mg of epinephrine or 20.0 ml of 0.5 % bupivacaine, or 0.75 % ropivacaine in a volume of 20.0 ml.