Comparison of Chloroprocaine Versus Lidocaine With Epinephrine, Sodium Bicarbonate, and Fentanyl for Epidural Extension Anesthesia in Elective Cesarean Delivery: A Randomized, Triple-blind, Noninferiority Study

Abstract

(Anesth Analg. 2021;132:666–675) To facilitate intrapartum cesarean delivery anesthesia, patients with ongoing neuraxial labor analgesia receive a more potent local anesthetic through the epidural catheter to establish surgical anesthesia. When this technique is successful, patients can forego other neuraxial or general anesthesia for cesarean delivery. The study institution uses 2 anesthetic solutions for epidural extension anesthesia: 3% chloroprocaine (CP), or a mixture of 2% lidocaine, epinephrine, sodium bicarbonate, and fentanyl (LEBF). Since the mixture takes time to prepare, CP is used for unanticipated emergencies on labor and delivery. This randomized, triple-blind, noninferiority study aimed to compare the surgical anesthesia onset times of CP and LEBF for epidural extension anesthesia for cesarean delivery.