Abstract
Two techniques of injection for epidural anaesthesia for Caesarean sections were studied. Forty-five patients were randomly divided into two groups. Patients in Group I received 20 ml of lidocaine two per cent with epinephrine via the needle at a rate of 5 ml · 30 sec-1 after a 3 ml test dose. Patients in Group II received the same dose of the same solution in increments of 5 ml injected through a catheter after a 3 ml test-dose. Each increment was injected in one minute with a delay of two minutes between injections. Top-up doses were given in both groups to obtain a T4 sensory level. There was no difference between the two groups in the quality of sensory block before delivery. However, the quality was significantly better in Group II after delivery (P = 0.02). The incidence of hypotension was 52.2 per cent in Group and 13.6 per cent in Group II (P = 0.014). There was no significant difference in maternal and umbilical venous lidocaine concentrations. We conclude that injection in fractional doses is a safer and more efficient technique for epidural anaesthesia for Caesarean section.
Résumé
Les auteurs ont étudié deux techniques ďinjection pour anesthésie épidurale lors de césariennes. Quarante-cinq patientes ont été divisées de façon aléatoire en deux groupes. Les patientes du groupe I ont reçu 20 ml de lidocaine deux pour cent avec épinéphrine par V aiguille à une vitesse ďinjection de 5 ml · 30 sec-1 après une dose-test de 3 ml. Les patientes du groupe II ont reçu la même dose du même agent via un cathéter épidural, par doses fractionnées de 5 ml après la dose-test. Les doses fractionnées furent injectées en une minute, à intervalle de deux minutes entre chacune des injections. Des doses supplémentaires furent ajoutées dans les deux groupes pour obtenir un niveau sensilif à T4. Il n’y a eu aucune différence entre les deux groupes quant à la qualité du bloc sensitif avant la naissance. Cependant, après la naissance, le bloc fut significativement meilleur dans le groupe II (P = 0.021 ). ľincidence ďhypotension fut de 52.2 pour cent dans le groupe I et de 13.6 pour cent dans le groupe II (P = 0.014). II n’y a pas eu de différence significative entre les niveaux plasmatiques de lidocaine dans les veines maternelles et ombilicales. Nous concluons que ľinjection en doses fractionnées est une technique à la fois plus sécuritaire et plus efficace pour ľanesthésie épidurale lors ďune césarienne.
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Crochetière, C.T., Trépanier, C.A. & Coté, J.J. Epidural anaesthesia for Caesarean section: comparison of two injection techniques. Can J Anaesth 36, 133–136 (1989). https://doi.org/10.1007/BF03011434
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DOI: https://doi.org/10.1007/BF03011434