Comparing Bupivacaine, Lidocaine, and a Combination of Bupivacaine and Lidocaine for Labor Epidural Activation: A Prospective, Randomized, Double-Blind Study

Mark F. Powell ； Kristin W. Jarzombek ； Kenton J. Venhuizen ； Michelle D. Tubinis ； Charity J. Morgan ； Michael A Frölich

《Asian Journal of Anesthesiology》 預刊文章 Pp. 1-6

https://doi.org/10.6859/aja.201908/PP.0004

摘要

Objective: Epidural anesthesia for the parturient is often provided in a clinical context where rapid onset of segmental analgesia is important; however, little is published on the ideal local anesthetic to safely achieve this onset. To fill this gap in knowledge, we studied bupivacaine and lidocaine, two local anesthetics (LA) commonly used for labor epidural activation, either as a single drug or in combination to determine the onset of epidural analgesia. Methods: In this double-blinded study, seventy-five patients were randomized into three groups (n = 25 each) for labor epidural activation: 10 mL of 0.25% bupivacaine, 10 mL of 1% lidocaine, or 5 mL of 0.25% bupivacaine plus 5 mL of 1% lidocaine. Patients were assessed for the first 20 min after drug administration at 5-min intervals. Data collected included sensory level to pinprick, maternal blood pressure, vasopressor administration, and peak motor blockade. Results: Data were analyzed on 71 of 75 patients. Time to loss of sensation to pinprick at the T_(10) dermatome in the bupivacaine group was significantly longer than the lidocaine group (p = 0.006), but the time to loss of sensation to pinprick at the T_(10) dermatome did not significantly differ in the bupivacaine plus lidocaine group when compared to both the bupivacaine (p = 0.114) as well as the lidocaine (p = 0.203) groups. Phenylephrine usage did not significantly differ amongst the three groups (p = 0.062). Conclusion: Lidocaine provides statistically significant faster onset of epidural analgesia when compared to bupivacaine only. Combining the two LA did not significantly affect onset.

關鍵字

epidural analgesia ； labor pain ； local anesthetics ； obstetrical analgesia