Fetal heart rate after epidural lidocaine and bupivacaine for elective cesarean section

• Published in: Anesthesiology (Philadelphia) 1991-09, Vol.75 (3), p.406-412
• Main Authors: Loftus, J R, Holbrook, R H, Cohen, S E
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia, Epidural; Anesthesia, Obstetrical; Apgar Score; Bupivacaine - pharmacology; Cesarean Section; Double-Blind Method; Female; Heart Rate, Fetal - drug effects; Humans; Infant, Newborn; Lidocaine - pharmacology; Male; Pregnancy; Prospective Studies
• ISSN: 0003-3022
• DOI: 10.1097/00000542-199109000-00005

This prospective double-blind study was designed to determine whether the fetal heart rate (FHR) changes that have been reported after epidural administration of bupivacaine and lidocaine during labor are present when larger doses of these drugs are given during elective cesarean section. Prior to inserting an epidural catheter, FHR and maternal vital signs were monitored during a control period in 60 healthy term parturients. Patients were randomly assigned to receive either 0.5% bupivacaine with 0.1 mEq sodium bicarbonate added to each 20 ml (n = 30) or 2% lidocaine with 1:300,000 epinephrine (n = 30). A 3-ml test dose of the study solution was injected via the catheter and was followed by an additional 17 ml, in increments; additional doses were administered as necessary to obtain surgical anesthesia. FHR and maternal vital signs were monitored for at least 20 min and the characteristics of the anesthetic block noted. At delivery, neonatal status was evaluated, and maternal and cord blood samples were obtained for local anesthetic assays and neonatal blood gases. The groups were similar with respect to maternal characteristics, onset of surgical anesthesia, time to delivery, and uterine incision-delivery interval. Maternal blood pressure decreased from control values in both groups (P less than 0.05), but there was no difference between the groups in either the incidence of hypotension or ephedrine requirements. Analysis of FHR tracings by a perinatologist blinded to the study group revealed no changes after anesthesia and no significant differences between the groups at any time in basal FHR, short- or long-term variability, or the incidence of accelerations or decelerations.