Abstract
This double-blind randomized study of 116 healthy women was undertaken to evaluate whether alkalinization potentiated the analgesic effects of epidural fentanyl-lidocaine for elective Caesarean section. After a test-dose of 3 ml, lidocaine 2% with adrenaline 1:200,000, all patients received 100 μg, fentanyl in 5 ml saline and they were then divided into two groups, to receive incremental doses of 5 ml lidocaine 2% with adrenaline 1:200,000 with or without 0.1 mEq · ml−1 sodium bicarbonate, to obtain anaesthesia to T4. The addition of bicarbonate to lidocaine resulted in a mean (SD)pH increase from 6.58 (0.01) to 7.14 (0.02) and in a mean PCO2 increase from 3.8 (0.8) to 345.1 (5.9) mmHg. Onset of sensory analgesia to the S1 segment as well as the interval between the block and the delivery of the baby were shorter in the bicarbonate group (respectively 15.4 (6.9) vs 18.9 (4.8) min and 28.9 (9.5) versus 33.9 (11.8) min; P < 0.01 and 0.05). No differences were noted in the onset to T4 or in the degree of motor block. The percentage of patients experiencing pain during surgery and requiring intravenous analgesics was higher in the group which did not receive bicarbonate (3% vs 16%; P < 0.05). There were no differences in intraoperative maternal side-effects, neonatal outcome or in maternal venous and umbilical venous and arterial lidocaine concentrations between the groups. The concentrations of fentanyl in maternal plasma, umbilical artery, and the umbilical artery to maternal vein ratio were greater in the alkalinized group (P < 0.001). In conclusion, alkalinization improves the quality and reliability of epidural anaesthesia provided with fentanyl and lidocaine for Caesarean section in healthy mothers.
Résumé
Cette étude randomisée à double inconnue est réalisée chez 116 patientes en bonne santé pour évaluer si l’alcalinisation potentialise les effets analgésiques de l’association fentanyllidocaïne en épidurale pour la césarienne programmée. Après une dose-test de lidocaïne 2% adrénalinée à 1:200,000 3 ml, toutes les patientes reçoivent fentanyl 100 μg dans du soluté physioloque et sont divisées en deux groupe. Elles reçoivent des doses progressives de lidocaine 2% adrénalinée à 1:200,000 5 ml avec ou sans bicarbonate de sodium 0,1 mEq · ml−1 jusquà ce que le niveau T4 soil atteint. L’addition de bicarbonate à la lidocaïne augmente en moyenne (±SD) le pH de 6,58 (0,01) à 7,14 (0,02) et la PCO2 en moyenne de 3,8 (0,8) à 345,1 (5,9) mmHg. Le debut de l’anesthésie sensorielle mesurée au niveau S1 et l’intervalle entre l’initiation du bloc et la naissance sont plus courts pour le groupe bicarbonate (respectivement 15,4 (6,9) min vs 18,9 (4,8) min et 28,9 (9,5) vs 33,9 (II,8) min; P < 0,01 et 0,05). On ne note pas de difference quant au début de l’analgésie à T4 ou au degré du bloc moteur. Le pourcentage de patientes qui ressentent de la douleur pendant la chirurgie et qui reçoivent un analgésique iv est plus élevé dans le groupe qui ne reçoit pas de bicarbonate (3% vs 16%; P < 0,05). On ne trouve pas de différence entre groupes pour l’incidence des effets secondaires, le pronostic néo-natal ou les concentrations plasmatiques ombilicales artérielles et veineuses. La concentration plasmatique de fentanyl dans l’artèreombilicale est plus élevée dans le groupe bicarbonate ainsi que le rapport veineux ombilical-artère matemelle (P < 0,001). En conclusion, l’alcalinisation améliore la qualité et la fiabilité de l’anesthésie épidurale produite par le fentanyl et la lidocaïne pour la césarienne de patientes en bonne santé.
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References
Crawford JS, Davies P, Lewis M. Some aspects of epidural block provided for elective Caesarean section. Anaesthesia 1976, 41: 1039–46.
Alahuhta S, Kangas-Saarela T, Hollmen AI, Edström HH. Visceral pain during Caesarean section under spinal and epidural anaesthesia with bupivacaine. Acta Anaesthesiol Scand 1990; 34: 95–8.
Paech MJ, Westmore MD, Speirs HM. A double-blind comparison of epidural bupivacaine and bupivacaine-fentanyl for Caesarean section. Anaesth Intensive Care 1990; 18: 22–30.
Celleno D, Capogna G, Sebastiani M, et al. Epidural analgesia during and after Caesarean delivery. Comparison of five opioids. Reg Anesth 1991; 16: 79–83.
King MJ, Bowden MI, Cooper GM. Epidural fentanyl and 0.5% bupivacaine for elective Caesarean section. Anaesthesia 1990; 45: 285–8.
Noble DW, Morrison LM, Brockway MS, McClure JH. Adrenaline, fentanyl or adrenaline and fentanyl as adjuncts to bupivacaine for extradural anaesthesia in elective Caesarean section. Br J Anaesth 1991; 66: 645–50.
Tackely RM, Coe AJ. Alkalinised bupivacaine and adrenaline for epidural Caesarean section. Anaesthesia 1988; 43: 1019–21.
Fernando R, Jones HM. Comparison of plain and alkalinized local anaesthetic mixtures of lignocaine and bupivacaine for elective extradural Caesarean section. Br J Anaesth 1991; 67: 699–703.
Kaufman JJ, Semo NM, Koski WS. Microelectrometric titration measurement of the pKa’s and partition and drug distribution coefficients of narcotics and narcotic antagonists and their pH and temperature dependence. J Med Chem 1975; 18: 647–55.
Amiel-Tison C, Barrier G, Shnider SM, Levinson G, Hughes SC, Stefani SJ. A new neurologic and adaptive capacity scoring system for evaluating obstetric medications in full-term newborns. Anesthesiology 1982; 56: 340–50.
Catchlove RFH. The influence of CO2 and pH on local anesthetic action. J Pharmacol Exp Ther 1972; 181: 298–309.
Bokesch PM, Raymond SA, Strichartz GR. Dependence of lidocaine potency on pH and PCO2. Anesth Analg 1987; 66:9–17.
McMorland GH, Douglas MJ, Axelson JE, et al. The effect of pH adjustment of bupivacaine on the onset and duration of epidural anaesthesia for Caesarean section. Can J Anaesth 1988; 35: 457–61.
Benhamou D, Labaille T, Bonhomme L, Perrachon N. Alkalinization of epidural 0.5% bupivacaine for Cesarean section. Reg Anesth 1989; 14: 240–43.
DiFazio CA, Canon H, Grosslight KR, Moscicki JC, Bolding WR, Johns RA. Comparison of pH-adjusted lidocaine solutions for epidural anesthesia. Anesth Analg 1986; 65: 760–64.
Capogna G, Celleno D, Varrassi G, et al. Epidural mepivacaine for Cesarean section: effects of a pH-adjusted solution. J Clin Anesth 1991; 3: 211–5.
Liepert DJ, Douglas MJ, McMorland GH, Gambling DR, Kim JHK, Ross PLE. Comparison of lidocaine CO2 two percent lidocaine hydrochloride and pH adjusted lidocaine hydrochloride for Caesarean section anaesthesia. Can J Anaesth 1990; 37: 333–6.
Parnass SM, Curran MJA, Becker GL. Incidence of hypotension associated with epidural anaesthesia using alkalinized and nonalkalinized lidocaine for Cesarean section. Anesth Analg 1987; 66: 1148–50.
Randalls B, Broadway JW, Browne DA, Morgan BM. Comparison of four subarachnoid solutions in a needle-through-needle technique for elective Caesarean section. Br J Anaesth 1991; 66: 314–8.
Bentley J. Pharmacokinetic approach.In: Smith G, Covino BG (Eds.). Acute Pain, London: Butterworths, 1985: 42–66.
Brose W, Cohen SE. Epidural lidocaine for Cesarean section: effect of varying epinephrine concentration. Anesthesiology 1988; 69: 936–40.
McLintic AJ, Danskin FH, Reid JA, Thorburn J. Effect of adrenaline on extradural anaesthesia, plasma lignocaine concentrations and the feto-placental unit during elective Caesarean section. Br J Anaesth 1991; 67: 683–9.
Foldes FF, Molloy R, McNall PG, Koukal LR. Comparison of toxicity of intravenously given local anesthetic agents in man. JAMA 1960; 172: 1493–8.
Eisele JH Jr. The use of short-acting narcotics in obstetric anesthesia and the effects on the newborn.In: Estafanous FG (Ed.). Opioids in Anesthesia. London: Butterworth, 1985: 100–5.
Hertzka RE, Gauntlett IS, Fisher DM, Spellman MJ. Fentanyl-induced ventilatory depression: effects of age. Anesthesiology 1989; 70: 213–8.
Abouleish E, Rawal N, Fallon K, Hernandez D. Combined intrathecal morphine and bupivacaine for Cesarean section. Anesth Analg 1988; 67: 370–4.
Hunt CO, Naulty JS, Bader AM, et al. Perioperative analgesia with subarachnoid fentanyl-bupivacaine for Cesarean delivery. Anesthesiology 1989; 71: 535–40.
Crawford JS. There is only a limited place for spinals in obstetrics. Acta Anaesthesiol Belg 1988; 39: 181–4.
Lyons G, Macdonald R. 29-gauge spinal needle (letter). Br J Anaesth 1991; 67: 222.
Lussos SA, Datta S. Anesthesia for cesarean delivery Part II: Epidural anesthesia, intrathecal and epidural opioids, venous air embolism. International Journal of Obstetric Anesthesia 1992; 4: 208–21.
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Capogna, G., Celleno, D., Costantino, P. et al. Alkalinization improves the quality of lidocaine-fentanyl epidural anaesthesia for Caesarean section. Can J Anaesth 40, 425–430 (1993). https://doi.org/10.1007/BF03009511
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DOI: https://doi.org/10.1007/BF03009511