Surgical Anesthesia, Cesarean Section Clinical Trial
Official title:
A Randomized, Double-blind Study Comparing 3% Chloroprocaine Versus 2 % Lidocaine/ Epinephrine/ Bicarbonate/ Fentanyl for Epidural Anesthesia in Elective Cesarean Delivery
Regional anesthesia is commonly used for elective and emergency cesarean delivery. It provides numerous safety advantages when compared to general anesthesia for both the mother and fetus1. Epidurals also have the added benefit of being able to provide pain relief throughout labor and in the event of cesarean delivery, epidural analgesia can be "extended" to provide surgical anesthesia. Numerous studies have been performed to assess the onset times of various local anesthetics when administered through an epidural catheter. Attempts to reduce anesthetic onset time and improve the quality of intraoperative analgesia have been attempted by using different local anesthetic solutions and by the addition of other drugs to the epidural solution (such as epinephrine, fentanyl and sodium bicarbonate).
Regional anesthesia is commonly used for elective and emergency cesarean delivery. It
provides numerous safety advantages when compared to general anesthesia for both the mother
and fetus1. Epidurals also have the added benefit of being able to provide pain relief
throughout labor and in the event of cesarean delivery, epidural analgesia can be "extended"
to provide surgical anesthesia. Numerous studies have been performed to assess the onset
times of various local anesthetics when administered through an epidural catheter. Attempts
to reduce anesthetic onset time and improve the quality of intraoperative analgesia have been
attempted by using different local anesthetic solutions and by the addition of other drugs to
the epidural solution (such as epinephrine, fentanyl and sodium bicarbonate).
A recent meta-analysis concluded that the optimum local anesthetic solution for extending a
labor epidural from analgesia to surgical anesthesia has yet to be determined 2. In 1994, a
retrospective study compared 1.5% lidocaine/bicarbonate/epinephrine mixture to 3%
chloroprocaine in parturients with pre-existing epidural catheters for urgent cesarean
delivery3. It was found that the chloroprocaine group had a significantly faster onset of
anesthesia compared to the lidocaine group. Both drugs provided excellent anesthesia. However
a high quality study comparing 3% chloroprocaine with 2% lidocaine/ epinephrine/ bicarbonate/
fentanyl (LEBF) in terms of anesthetic onset times has yet to be performed.
Women in labor frequently request an epidural to provide pain relief. Epidural pain relief is
commonly provided by the administration of a low concentration of local anesthetic and opioid
solution through an epidural catheter. This solution is delivered by an automated epidural
infusion pump. In the event that a cesarean delivery is required, the pre-existing epidural
is frequently used to administer a higher concentration anesthetic solution to allow pain
free cesarean delivery. This is commonly referred to as an "epidural top up" or as an
"extension of the epidural block." Standard practice at University of Arkansas for Medical
Sciences (UAMS) for an epidural top up is Lidocaine, Epinephrine, Bicarbonate and Fentanyl
(LEBF) or 3% chloroprocaine. These two mixtures are routinely and almost exclusively used for
epidural cesarean delivery. The decision on which mixture to use is based solely on physician
preference. It is likely that the LBEF mixture is used more frequently but the investigators
consider both local anesthetic mixtures as equals and the standard of care at UAMS. The
investigators do not use any other local anesthetics (unless there are very specific
reasons).
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