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.