Abstract
This double-blind randomized study compared the effects of an epidural injection of lidocaine hydrochloride 2% (HCl) (Group I), alkalinized lidocaine 2% (1 ml NaHCO3 per 10 ml of solution) injected either immediately (Group 2) or one hour after preparation (Group 3) in 45 parturients (n = 15 per group) scheduled for elective Caesarean section. Each patient received 16 ml of one of the three solutions. The mean pH values measured just before administration with a pH- meter PHM 64 Metrohm AG were 6.77 for the HCl lidocaine 2% solution, 7.34 for the freshly alkalinized solution and 7.35 for the solution prepared one hour before injection. The median maximal sensory level (range) observed was T3 (Tg− C7), T4 (T5−C8) and T4 (T6− C6), obtained after 19 ± 6 min, 18 ± 8 min and 16 ± 6 min respectively for each group. A motor block of grade 2 or 3 on the Bromage scale was obtained in 11, 10 and 14 patients respectively. No failure was observed although 3, 5, and 2 patients in Groups 1, 2, and 3 respectively required a supplementary bolus 20 min after the initial injection because of inadequate sensory level or pain at the operative site. In conclusion, this study shows that neither fresh alkalinization of 2% lidocaine nor the delay of one hour between preparation and injection of the alkalinized solution influences the onset or quality of epidural anaesthesia for elective Caesarean section.
Résumé
Cette étude randomisée, réalisée en double- aveugle, a comparé les effets anesthésiques de la lidocaine HCl 2%, de son alcalinisation immédiate à raison de 0,1 meq par ml, et d’un délai d’une heure entre la préparation de la solution alcalinisée et son injection, en césarienne élective sous anesthésie péridurale continue chez 45 patientes. Chaque patiente a reçu une injection péridurale de 16 ml de la solution correspondant au groupe auquel elle a été attribuée. Les pH moyens mesurés étaient 6.77 pour la lidocaine 2% seule, 7.34 pour la solution fraîchement alcalinisée et 7.35 pour la solution alcalinisée préparée à l’avance. La valeur médiane (étendue) du niveau sensitif maximal était à D3 (D8− C7), D4 (D5−C8), et D4 (Dg− C6), obtenu apr19 ± 6 minutes, 18 ± 8 min et 16 ± 6 min pour les trois groupes respectivement. Un bloc moteur de degré 2 ou 3 selon l’échelle de Bromage a été obtenu chez 11, 10 et 14 patientes respectivement. En conclusion, les résultats de cette étude indiquent d’une part que l’alcalinisation de la lidocaine 2%, et d’autre part qu’un délai d’une heure entre l’alcalinisation de la solution et son injection n’influencent pas les caractéristiques d’une anesthésie péridurale pour césarienne.
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Gaggero, G., Meyer, O., Van Gessel, E. et al. Alkalinization of lidocaine 2% does not influence the quality of epidural anaesthesia for elective Caesarean section. Can J Anaesth 42, 1080–1084 (1995). https://doi.org/10.1007/BF03015092
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DOI: https://doi.org/10.1007/BF03015092