Determination of the minimum local analgesic concentration of epidural chloroprocaine hydrochloride in labor

Abstract

The aim was to determine the effective concentration in 50% of patients (EC 50) of chloroprocaine in the first stage of labor. A constant dose modification of a model where EC 50 was previously defined as the minimum local analgesic concentration (MLAC) was used. Parturients ( n=36) requesting epidural analgesia in labor, at cervical dilatation not exceeding 7 cm, were enrolled into this prospective, double-blinded study. After placing a lumbar epidural catheter, chloroprocaine 150 mg diluted to the concentration being evaluated was given. The concentration was determined by up-down sequential allocation. The volume of the bolus ranged from 15 to 50 ml. Efficacy was assessed using 100 mm visual analogue pain scores with 10 mm or less within 30 min defined as effective. MLAC (95%CI) was 0.42%w/v (0.34 to 0.5) using the formula of Dixon & Massey and as a sensitivity test was 0.4%w/v (0.35 to 0.46) using probit regression analysis. In conclusion, MLAC of chloroprocaine was 0.42%w/v in these parturients, equivalent to 14 millimolar solution. This study confirmed that concentration rather than dose could be used as a measure of efficacy in this constant dose model.