Safety and efficacy of epinephrine added to bupivacaine for lumbar epidural analgesia in obstetrics

The effects of epidural bupivacaine with and without 1:300,000 epinephrine on uterine activity, progress of labor, fetal heart rate, maternal blood pressure and heart rate, newborn Apgar scores, neonatal acid-base status, and Neurologic and Adaptive Capacity Scoring System (NACS) were compared in 32 parturients during labor and delivery. Patients in group I (n = 16) received 0.5% bupivacaine with 1:300,000 epinephrine and those in group II (n = 16) received 0.5% bupivacaine alone. Addition of epinephrine to bupivacaine had no significant effects on uterine activity, duration of first or second stages of labor, fetal heart rate and variability, or the incidence of abnormal fetal heart rate patterns. Maternal hypotension occurred less frequently in group I than in group II patients (P less than 0.05). Apgar scores, neonatal acid-base status, and the NACS were equally good in the two groups. Duration of analgesia was significantly longer in group I than in group II (186.8 +/- 11.6 vs 85.3 +/- 6.1 (mean +/- SEM) min, P less than 0.001). It is concluded that adding epinephrine to bupivacaine during epidural anesthesia in the normal parturient has no adverse effects on either mother, fetus, neonate, or the progress of labor; and that it significantly prolongs the duration of anesthesia and decreases the incidence of maternal hypotension.     

Maternal, fetal, and neonatal effects of lidocaine with and without epinephrine for epidural anesthesia in obstetrics

The effects of epidural lidocaine with and without 1:300,000 epinephrine on uterine activity, progress of labor, fetal heart rate, maternal blood pressure and heart rate, newborn Apgar scores, neonatal acid-base status, and the Neurologic and Adaptive Capacity Scoring System were compared in 30 parturients during labor and delivery. Patients in group I (n = 16) received 1.5% lidocaine with 1:300,000 epinephrine and those in group II (n = 14) 1.5% lidocaine alone. Addition of epinephrine to lidocaine did not have any significant effects on uterine activity, duration of first or second stages of labor, fetal heart rate variability, or the incidence of abnormal fetal heart rate patterns. Maternal heart rate and the incidence of hypotensive episodes did not differ significantly between the two groups of patients. Apgar scores, neonatal acid-base status, and the NACS were equally good in the two groups. Duration of analgesia was significantly longer in group I as compared to group II patients (106.9 +/- 6.6 vs 66.2 +/- 4.4 min, P less than 0.001). Umbilical venous concentrations of lidocaine and umbilical vein to maternal vein ratios of lidocaine were significantly higher in group II patients (P less than 0.05). It is concluded that addition of epinephrine to lidocaine during epidural anesthesia in the normal parturient has no adverse effects on mother, fetus, neonate, or the progress of labor and it significantly prolongs the duration of anesthesia and limits the placental transfer of lidocaine.     

Continuous infusion epidural analgesia in parturients receiving bupivacaine, chloroprocaine, or lidocaine--maternal, fetal, and neonatal effects

The effects of epidural analgesia for labor and delivery using a continuous infusion technique on fetal heart rate, uterine activity, maternal blood pressure, Apgar scores, neonatal acid-base status, and the Neurologic and Adaptive Capacity Scoring System were studied in 61 parturients. Group I (n = 23) received initial test and therapeutic doses of 2 and 6 ml of 0.5% bupivacaine followed by an infusion of 0.125% at a rate of 14 ml/hr. Group II (n = 19) received 2 and 6 ml of 2% chloroprocaine followed by an infusion of 0.75% at a rate of 27 ml/hr. Group III (n = 19) received 2 and 6 ml of 1.5% lidocaine followed by an infusion of 0.75% at a rate of 14 ml/hr. None of the three local anesthetics used had any significant effect on baseline fetal heart rate or uterine activity. In cases in which monitoring of fetal heart rate was both technically satisfactory and continuous, late and variable decelerations in fetal heart rate were seen in 10 of 17, 3 of 18, and 2 of 19 of the fetuses in groups I, II, and III, respectively. The incidence was significantly higher in group I than in groups II or III (P less than 0.05). Apgar scores and neonatal acid-base status were equally good in all three groups. Neurologic and adaptive capacity scores did not differ among the three groups of neonates, nor did any of the neonates in the three groups score lower than a control group of 19 neonates whose mothers did not receive any analgesia or medications for labor and delivery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Neonatal responses to alphaprodine administered during labor

The effect of intravenously administered alphaprodine on newborn Apgar scores, neonatal acid-base status, and the Neurologic and Adaptive Capacity Scoring System (NACS) were compared in 30 parturients. Patients in group 1 (n = 15) received 20-40 mg increments of alphaprodine, with a total dose of 39.3 +/- 3.7 mg (mean +/- SEM). Group 2 patients (n = 15) received no medication during labor. Apgar scores, neonatal acid-base status, and the NACS were equally good in the two groups. The concentrations of alphaprodine in maternal vein, umbilical vein, and umbilical artery at delivery were measured using a gas-chromographic mass spectrophotometric technique. The results showed an umbilical vein-to-maternal vein ratio of 0.52 +/- 0.09. It is concluded that when administered as in this study, alphaprodine has no adverse effects on the neonate.     

Addition of epinephrine to epidural ropivacaine during labour--effects on onset and duration of action, efficacy, and systemic absorption of ropivacaine

Addition of epinephrine to epidural anaesthetic solutions may enhance efficacy and duration of analgesia. We postulated that addition of epinephrine 5 microg.mL(-1) to epidural ropivacaine would improve efficacy, decrease systemic absorption and reduce neonatal effects. Twenty-one multiparous women were studied. An initial dose of ropivacaine 30 mg followed by an infusion of ropivacaine 10 mg.h(-1) was given via a lumbar epidural catheter. According to random allocation, epinephrine 5 microg.mL(-1) was added to ropivacaine. Ropivacaine concentrations were measured in maternal venous plasma after one hour of infusion and in both umbilical venous and maternal plasma at delivery. Neonatal neurologic and adaptive capacity score (NACS) tests were performed at 2 and 24 h postpartum. All women delivered vaginally. The groups had similar ropivacaine dose requirements, epidural-delivery intervals and satisfaction scores. Bromage scores for motor block were greater in the epinephrine group (2; range: 1-3) than controls (1; range: 0-2). Mean plasma ropivacaine concentrations (+/-SD) were less in the epinephrine group (0.17 +/- 0.05 mg.L(-1), n = 10) than controls (0.31 +/- 0.14 mg.L(-1), n = 11; P < 0.05) after one h of infusion but not at delivery. UV ropivacaine concentrations and NACS scores were similar in the two groups. The addition of epinephrine to ropivacaine decreases maternal plasma concentrations after one h of epidural infusion but also increases motor block.     

Effect of standard diluted epinephrine infusion on epidural anesthesia in labor

BACKGROUND AND OBJECTIVES: Epinephrine is used with local anesthetics to prolong the duration of epidural analgesia and decrease the peak plasma concentrations of local anesthetics. However, the duration of labor may be prolonged because epinephrine reduces uterine activity. We designed a prospective, randomized, and doubleblind study to examine the effects of epinephrine infusion on the quality of analgesia and plasma concentration of local anesthetic, as well as the effect on the uteroplacental circulation, duration of the first or second stage of labor, and fetal outcome. METHODS: Twenty-four parturients received continuous epidural bupivacaine 0.125% (8 mL/h) combined either with epinephrine (40 microg/h) (n = 12) or without epinephrine (n = 12) for analgesia during labor. If patients requested additional analgesia, a bolus of 1% or 1.5% lidocaine (6 to 10 mL) was given. RESULTS: Only the plain bupivacaine group required additional lidocaine. However, epinephrine infusion prolonged the median (range) duration of the second stages of labor: 69 (21 to 231) minutes with epinephrine group versus 31 (8 to 99) minutes without epinephrine group (P < .05), and decreased pH in umbilical artery at the time of delivery. Epinephrine infusion did not change the uterine and umbilical blood flow, which were determined as the resistance indices. Changes in the fetal heart rate and Apgar score were also comparable. Epinephrine significantly reduced the umbilical venous to maternal arterial bupivacaine concentration (P < .05). CONCLUSIONS: A standard diluted epinephrine infusion (40 microg/h) into epidural space decreased anesthetic requirements. The possibility of the prolonged duration of labor remains a problem.     

Epidural lidocaine for cesarean delivery of the distressed fetus

Lidocaine with epinephrine and sodium bicarbonate has a rapid onset of action. We therefore wished to compare its use with that of chloroprocaine for urgent cesarean delivery. Thirty parturients for cesarean section under epidural anesthesia were divided into three groups. Group 1 required elective cesarean section and served as the control group for neonatal lidocaine levels. Groups 2 and 3 had been receiving epidural infusions of 0.125% bupivacaine with epinephrine 1:400,000 and required urgent cesarean section. They were randomized to receive either 1.5% lidocaine with epinephrine or 3% chloroprocaine, both with sodium bicarbonate 2 ml in a total volume of 25 ml. All patients had adequate anesthesia and none required supplementation. The time from completion of injection to the achievement of a T4 sensory level was significantly shorter in the chloroprocaine group (3.1 vs. 4.4 min). There were no differences in Apgar scores or Neurologic and Adaptive Capacity Scores between the lidocaine and chloroprocaine groups. Lidocaine was detectable in maternal serum from four of the urgent cases and all of the elective cases. It was detectable in five neonates from the elective group but none from the emergency group. In parturients with preexisting epidural catheters and a baseline epidural infusion to maintain a T10 sensory level, chloroprocaine is faster in onset than lidocaine, but the difference in this study was only 1.3 min, and both agents provided excellent anesthesia.     

Effect of epidural epinephrine infusion with bupivacaine on labor pain and mother-fetus outcome in humans

BACKGROUND AND OBJECTIVES: Epinephrine is used with local anesthetics to prolong the duration of epidural analgesia and decrease the peak plasma concentrations of local anesthetics. In the practice of obstetric anesthesia, the utero-placental and fetal effects of epinephrine are controversial issues. We designed a prospective, randomized, and double-blind study to examine the effects of epinephrine infusion on the quality of analgesia and uterine or umbilical blood flows with Doppler ultrasound, as well as the duration of the first or the second stage of labor, and fetal outcome. METHODS: Twenty-eight parturients received continuous epidural bupivacaine 0.25% (4 mL/h) combined either with epinephrine (20 microg/h) (n = 13) or without epinephrine (n = 15) for analgesia during labor. If patients requested additional analgesia, an additional bolus of 1% or 1.5% lidocaine (6 to 10 mL) was administered. RESULTS: The total amount of additional lidocaine was greater in the plain bupivacaine group (130 [0, 280] mg; median [25th, 75th percentile] with P < .05) than in the epinephrine group (0 [0, 60] mg). Epinephrine infusion did not alter the resistance of the uterine and umbilical arteries as measured by resistance index. The duration of the first or second stages of labor did not significantly differ in the 2 groups. Epinephrine infusion did not change the fetal heart rate or the blood gas data in the umbilical artery. CONCLUSIONS: A low-dose epidural infusion of epinephrine decreased anesthetic requirements.     

程控硬膜外间歇脉冲注入与持续背景输注用于分娩镇痛的比较

目的比较程控硬膜外间歇脉冲注入(programmed intermittent epidural bolus,PIEB)和持续背景输注(CEI)两种模式联合PCEA用于分娩镇痛的临床效果。方法自愿接受分娩镇痛足月、单胎和头位初产妇200例,随机分为两组,每组100例。在宫口扩张2~3 cm时采用硬膜外阻滞行分娩镇痛。PIEB组背景输注剂量为8 ml/h,给药速度为6 ml/min,每小时给药一次;CEI组以8ml/h的速度持续给药。观察产妇镇痛前(T0)、镇痛后10 min(T1)、30 min(T2)、1 h(T3)、2 h(T4)、宫口开全时(T5)、分娩时(T6)、分娩后1 h(T7)BP、VAS评分、改良Bromage评分;PCEA追加次数、罗哌卡因、舒芬太尼的用量、宫缩情况、胎心率、产程时间、镇痛时间、分娩方式、产妇使用催产素、不良反应、新生儿Apgar评分、产妇满意度评分。结果 T4~T6时PIEB组VAS评分明显低于CEI组(P0.01)。PIEB组PCEA追加次数、药物用量明显少于CEI组(P0.05),PIEB组产妇满意度明显高于CEI组(P0.05)。两组产妇的血压、宫缩持续时间和间隔时间、胎心率、产程、镇痛时间、分娩方式、使用催产素比例、不良反应发生率及新生儿Apgar评分差异无统计学意义。结论与采用CEI+PCEA模式比较,PIEB+PCEA模式的PCEA追加率更低、用药量更少、VAS评分更低、产妇的满意度更高,而不良反应并没有增加。     

Intrathecal labor analgesia with bupivacaine and sufentanil: the effect of adding 2.25 microg epinephrine

BACKGROUND AND OBJECTIVES: Epinephrine, 25 microg and 200 microg, has been found to prolong the duration of intrathecal labor analgesia when added to an opioid. In our hospital we use the standard epidural mixture, prepared by the pharmacist, containing epinephrine 1:800,000; i.e., 1.25 microg/mL for both spinal and epidural labor analgesia. We wanted to evaluate whether such a low dose, depending on its effect on duration or quality of analgesia, should be maintained or deleted in future mixtures. METHODS: Forty-five term parturients were randomly assigned to receive 1.8 mL intrathecally of a mixture containing bupivacaine 0.125% and sufentanil 0.75 microg/mL with or without epinephrine 1.25 microg/mL. The quality and duration of analgesia, side effects, and obstetric/neonatal outcome were compared. RESULTS: For both combinations, the onset until the first painless contraction was between 5 and 6 minutes. Most patients were pain free during the second uterine contraction. The duration of complete analgesia was 93.2 +/- 24.2 minutes in the epinephrine group and 79.3 +/- 18.1 minutes for patients not receiving epinephrine (P = .014). The quality of the block, bupivacaine consumption, side effects, and obstetric/neonatal outcome were not different between groups. CONCLUSIONS: It was concluded that epinephrine in a dose as low as 2.25 microg significantly prolonged the duration of intrathecal analgesia of bupivacaine-sufentanil by 15 minutes. No other differences were noticed. Diluting the commercially available bupivacaine 0.5% with epinephrine 1:200,000 may avoid the need of freshly prepared epinephrine solutions.     

Anaesthetic technique for elective caesarean section and neurobehavioural status of newborns

Ninety healthy parturients undergoing elective caesarean section were randomly allocated to receive either general (n = 30), epidural (n = 30) or spinal (n = 30) anaesthesia. Acid-base status, Apgar score and neurobehavioural status, using the neurologic and adaptive capacity scoring (NACS) system, were studied in the newborn. Apgar scores and acid-base parameters were similar in all the three groups. NACS testing revealed significantly more vigorous babies in the spinal anaesthesia group than in the other two groups at 15 min and 2 h interval after delivery, despite a higher incidence of maternal hypotension. We conclude that newborns tend to have a better neurobehavioural status in the early post-delivery period if their mothers receive spinal anaesthesia rather than general or epidural anaesthesia for caesarean section.     

曲马多对母婴乳酸盐和新生儿神经行为的影响

目的　研究曲马多对母婴血乳酸盐和新生儿神经行为与适应能力评分 (NACS)的影响。方法　 6 0例足月妊娠剖宫产产妇随机分三组 :T0 组 ,2 0例 ,肌注 0 9%氯化钠 2ml;T1组 2 0例 ,肌注曲马多 1 5mg/kg ;T2 组 ,2 0例 ,肌注曲马多 2mg/kg。各组肌注后开始麻醉 ,三组均采用脊麻与硬膜外联合阻滞。观察指标 :新生儿生后 15min的Apgar评分及新生儿生后 15min的NACS ;胎儿娩出时采脐动、静脉血和母体动脉血各 2ml,行血乳酸值测定及血气分析。结果　三组新生儿Apgar评分无明显差异 ,T0 组NACS明显高于T1组 (P <0 0 5 )和T2 组 (P <0 0 1) ;T2 组脐动、静脉血乳酸值明显高于T1组 (P <0 0 5 )和T0 组 (P <0 0 1) ;母体乳酸值三组间无明显差异 ;T2 组母体和脐动、静脉血PaCO2 明显高于T0 组 (P <0 0 1) ,T2 组脐动、静脉血SaO2 明显低于T0 组 (P <0 0 5 )。结论　剖宫产术前肌注曲马多 1 5mg/kg对新生儿无明显不良影响。但 2mg/kg曲马多肌注具有呼吸抑制作用 ,使脐动、静脉血乳酸盐增加 ,对新生儿NACS有一过性影响     

Levobupivacaine-sufentanil with or without epinephrine during epidural labor analgesia

In a prospective, randomized, double-blind study, we investigated whether epinephrine increased the efficacy of levobupivacaine and sufentanil during epidural labor analgesia. Seventy term parturients received an epidural injection of levobupivacaine 0.125% and sufentanil 0.75 microg/mL with or without 1:800,000 epinephrine. After an initial dose of 10 mL, a patient-controlled analgesia pump was started. Total and hourly drug consumption, pain scores using the visual analog scale, sensory and motor block, duration of labor, vital variables, maternal and neonatal outcome, and side effects were compared. If the parturients experienced insufficient pain relief during the study, even after a rescue dose of 10 mL, they were excluded from further study and received 10 mL of bupivacaine 0.125% and sufentanil 0.75 microg/mL with 1:800,000 epinephrine. Hourly drug consumption, rescue dosing, and pain scores at 15 min and 20 min were lower in the epinephrine group. The incidence of motor block and duration of the second stage of labor tended to be higher in the epinephrine group and were associated with lower Apgar scores at 1 and 5 min. These findings suggest that the addition of epinephrine intensifies the effects of epidural levobupivacaine and sufentanil but may cause more motor block.     

Maternal and neonatal effects of adding epidural sufentanil to 0.5% bupivacaine for cesarean delivery.

STUDY OBJECTIVE: To determine the maternal and fetal effects of the addition of epidural sufentanil to 0.5% bupivacaine for cesarean delivery. DESIGN: Randomized, double-blind, prospective study. SETTING: University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium. PATIENTS: Sixty women at term scheduled for elective cesarean section, all of whom had elected epidural anesthesia. INTERVENTIONS: The 60 women were divided into three groups of 20, with each group receiving a different 1 ml study solution: saline (control) or sufentanil 20 micrograms or sufentanil 30 micrograms added to 0.5% bupivacaine and epinephrine (1:200,000). MEASUREMENTS AND MAIN RESULTS: In the mother, the quality of anesthesia, the duration of postoperative analgesia, the volume of anesthetic, and the frequency of side effects were examined. The neonates were evaluated at 5 and 10 minutes after birth by Apgar scores and between 60 and 120 minutes after birth by both the screening test developed by Prechtl and the Neurological and Adaptive Capacity Scoring System. Immediately after delivery, maternal and umbilical vein blood were drawn and assayed for sufentanil levels. Adding sufentanil significantly improved the quality of anesthesia without depressing the neurobehavioral status of the baby. CONCLUSION: The epidural injection of sufentanil added to 0.5% bupivacaine with epinephrine improved the quality of anesthesia during elective cesarean section without jeopardizing the safety of the baby.     

Patient-controlled epidural analgesia for labor pain: effect on labor, delivery and neonatal outcome of 0.125% bupivacaine vs 0.2% ropivacaine

The objective was to evaluate the influence of patient-controlled epidural analgesia (PCEA) using low doses of bupivacaine vs. ropivacaine, on labor pain, motor blockade, progression of labor, delivery and neonatal outcome. This randomized double blind study included 565 parturients. All received a 5-mL/h infusion and PCEA (5-mL boluses with a 20-min lockout, maximum volume 20 mL/h) of either 0.125% bupivacaine (n = 313: 165 nulliparous, 148 parous) or 0.2% ropivacaine (n = 252: 113 nulliparous, 139 parous). Pain score, lower limb motor block, sensory levels, local analgesic doses required, hemodynamic parameters, side effects and complications were assessed. Obstetric variables included cervical dilation at epidural insertion, incidence of ruptured membranes and their duration, use of oxytocin, fetal heart rate changes, duration of labor, mode and outcome of delivery, and use of invasive and non-invasive fetal monitoring. Neonatal characteristics included birth weight, Apgar scores, umbilical artery pH, serum bilirubin, hypoglycemia, need for assisted ventilation, sepsis or sepsis study, feeding difficulties and respiratory distress syndrome. Ropivacaine 0.2% was equianalgesic with 0.125% bupivacaine, but produced less motor block (P < 0.0001). There were no significant differences, however, in duration of labor, delivery type or neonatal outcome.     

Epidural lidocaine versus 2-chloroprocaine for fetal distress requiring urgent cesarean section

Chloroprocaine is a local anesthetic widely used for the urgent cesarean delivery of a distressed fetus in an mother with a epidural catheter because of its quick onset and short half-life. However, chloroprocaine has disadvantages that include decreased effectiveness of subsequently administered epidural amides and narcotics. Lidocaine with freshly added epinephrine and sodium bicarbonate is also rapid in onset, although there is the theoretical concern regarding the accumulation of ionized lidocain in the acidotic fetus. A retrospective review revealed that though the drug administration to incision time was significantly faster (P < 0.005) for 3% chloroprocaine, both 3% chloroprocaine and 1.5% lidocaine were clinically effective. There were no differences in neonatal Apgar scores or neonatal umbilical cord pH values between the two treatment populations, offering lidocaine as an attractive alternative to chloroprocaine.     

Continuous infusion epidural analgesia during labor: a randomized, double-blind comparison of 0.0625% bupivacaine/0.0002% fentanyl versus 0.125% bupivacaine

The analgesic efficacy of the continuous epidural infusion of 0.0625% bupivacaine/0.0002% fentanyl was compared with the infusion of 0.125% bupivacaine alone in a randomized, double-blind study of nulliparous women. Each patient received, in sequence: 1) 3 ml of 0.5% bupivacaine with 1:200,000 epinephrine; 2) 6 ml of study solution 1 (bupivacaine-fentanyl group: 0.125% bupivacaine/0.0008% fentanyl; bupivacaine-only group: 0.25% bupivacaine alone); and 3) a continuous epidural infusion of study solution 2 at a rate of 12.5 ml/h (bupivacaine-fentanyl group: 0.0625% bupivacaine/0.0002% fentanyl; bupivacaine-only group: 0.125% bupivacaine alone). The epidural infusion was discontinued at full cervical dilatation, but patients who lacked perineal anesthesia received one or two 5-ml boluses of study solution 3 (bupivacaine-fentanyl group: 0.0625% bupivacaine alone; bupivacaine-only group: 0.125% bupivacaine alone). During the first stage of labor, 36 of 41 (88%) women in the bupivacaine-fentanyl group, and 37 of 39 (95%) women in the bupivacaine-only group, had analgesia of excellent or good quality (P = NS). During the second stage, 22 of 37 (59%) women in the bupivacaine-fentanyl group, and 23 of 35 (66%) women in the bupivacaine-only group, rated their analgesia as excellent or good (P = NS). Women in the bupivacaine-only group were more likely to have motor block at full cervical dilatation (P less than .001). There was no significant difference between groups in duration of the second stage of labor, duration of pushing, position of the vertex before delivery, method of delivery, Apgar scores, or umbilical cord blood gas and acid-base values.(ABSTRACT TRUNCATED AT 250 WORDS)     

Epidural obstetric analgesia, maternal fever and neonatal wellness parameters

OBJECTIVE: To study the relation between epidural analgesia and the development of maternal fever during labor and childbirth, and to determine the possible relation between that association and neonatal welfare and in the performance of tests to rule out sepsis in newborns. PATIENTS AND METHODS: Prospective study of all women who gave birth at Fundación Hospital Alcorcón over a period of 3 years. All the women were offered epidural analgesia based on infusion of 0.0625% bupivacaine and 2 microg x mL(-1). Data collected were age, nulliparity, epidural analgesia infusion, induction of labor, uterine stimulation with oxytocin, type of birth, fetal weight, duration of dilation and expulsion, Apgar score (at 1 and 5 minutes), umbilical artery pH, and maternal temperature. RESULTS: Data for 4364 women were analyzed. Fever developed during labor in 5.7%; 93.7% of the fevers occurred in women receiving epidural analgesia (P<0.05). Logistic regression analysis revealed that independent risk factors for the development of fever were epidural analgesia (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.05-3.04), nulliparity (OR, 2,929; 95% CI, 2.005-4.279), fetal weight (OR, 1.484; 95% CI, 1.102-2.001), and duration of labor (OR, 1.003; 95% CI, 1.003-1.004). No significant differences in Apgar score at 5 minutes or umbilical artery pH were found between the women with and without fever. Tests to rule out sepsis were ordered for 85.1% of the infants of mothers with fever after epidural analgesia. CONCLUSIONS: Epidural analgesia was associated with greater risk of developing fever in mothers giving birth, but that association had no repercussion on the neonatal wellness parameters studied.     

Paracervical block with 2-chloroprocaine

Thirty healthy term gravidas in active labor received a paracervical block (PCB) with the ester-type local anesthetic, 2-chloroprocaine (2CP). Good to excellent pain relief resulted in all but 1 case. The duration of action was short (mean 38.9 min), requiring repeat blocks in 6/30 cases. Fetal heart rate and uterine contractions were electronically monitored, and fetal acid-base status was periodically checked by fetal scalp pH measurements. PCB-related fetal bradycardia was observed in 3 cases, but in only 1 case was PCB the only cause for the bradycardia. Fetal acidosis was not observed. No instance of neonatal depression or acidosis as expressed by the 1- and 5-minute Apgar scores and cord blood acid-base evaluation was observed. No maternal complications were observed. It is concluded that paracervical block using 2CP is an effective though short-acting method of pain relief which, when properly monitored, is safe for both mother and fetus.     

Anesthesia for cesarean section--effects on neonates

The effects of general and regional anesthesia on neonates after cesarean section have been studied mainly on elective cases. In this paper we studied infants delivered by elective and nonelective cesarean section at the Winnipeg Women's Hospital from 1975 to 1983 (n = 3940) to determine the effect of anesthetic technique on neonatal outcomes. A trained anesthesia nurse interviewed all parturients and reviewed their antepartum, labor and delivery, and anesthesia records. Assessments of neonatal outcomes were based on 1- and 5-minute Apgar scores, need for positive pressure oxygen by mask or intubation, and neonatal deaths (within 30 days). These outcomes were determined in three subgroups of neonates delivered by cesarean section: those delivered by elective section, those delivered by urgent cesarean section for dystocia or failure of labor to progress, and those delivered by section because of fetal distress. Overall, 12.5% of the infants had 1-minute Apgar scores of 4 or less, and 1.4% had 5-minute Apgar scores of 4 or less. Neonates born to mothers given general anesthesia had worse outcomes than those born to mothers given regional anesthesia. Among neonates delivered after elective section, general anesthesia was associated with a higher incidence of low Apgar scores at 1 minute. In neonates delivered by nonelective section, general anesthesia was associated with higher rates of low Apgar scores at 1 and 5 minutes as well as greater requirements for intubation and artificial ventilation. There were no differences seen in neonatal death rates with general and regional anesthesia in the three groups.(ABSTRACT TRUNCATED AT 250 WORDS)