Low-dose epidural top up for emergency caesarean delivery: a randomised comparison of levobupivacaine versus lidocaine/epinephrine/fentanyl

Levobupivacaine for Regional Anesthesia and Pain Management

“…89,90 Levobupivacaine 0.5% was found to be similar in onset and quality of analgesia when compared to ropivacaine 0.75%. 87 Levobupivacaine seems to behave similarly to bupivacaine at equivalent mg doses [86][87][88] ; however, lowerlimb motor block appeared to be longer, though less intense with levobupivacaine in one study.…”

“…88 The increase in duration of motor block with levobupivacaine is surprising given that the epidural MLAC for motor block show that levobupivacaine is slightly less potent than bupivacaine. 33,41 When levobupivacaine 0.5% was compared to 1.8%-2% lignocaine mixtures, levobupivacaine performed less well, either requiring more analgesia supplement, 89 or taking longer to achieve appropriate blockade. 90 On the other hand, this finding was not borne out in the study by Sia et al, 35 who found similar results between levobupivacaine 0.5% and 2% mixtures.…”

Epinephrine Administered With Lidocaine Solution Does Not Worsen Intrathecal Lidocaine Neurotoxicity in Rats

“…These results add support to the above clinical reports. In this regard, the combination of 5 Kg 6 or 100 Kg 7 epinephrine and lidocaine is sometimes used to induce epidural anesthesia in obstetric patients to obtain rapid-onset 6,7 or superior-quality sensory block. 6 Thus, epinephrine used at these low doses in epidural anesthesia may be safe and not associated with neural damage.…”

“…3 The exact effect of epinephrine when combined with lidocaine remains controversial because it is reported by some to enhance lidocaine neurotoxicity, 4 whereas others indicated that it has no such effect. 3 Epinephrine administered with lidocaine for epidural anesthesia was also reported to have the beneficial effect of inducing rapid-onset 5,6 or enhanced sensory block, 6 especially in obstetrics. However, epinephrine could worsen lidocaine neurotoxicity when injected in the subarachnoid space based on its vasoconstrictive properties.…”

Effects of Epidural Fentanyl on Speed and Quality of Block for Emergency Cesarean Section in Extending Continuous Epidural Labor Analgesia Using Ropivacaine and Fentanyl

“…Retrospective power analysis revealed that more than 200 patients would be required to have 80% power of detecting the difference we observed. Recently, a study was conducted by Balaji et al (14). They showed a significantly faster onset (15.2 vs. 10.7 min) of block to T6 and fewer intraoperative supplements in the use of lidocaine-fentanyl-epinephrine compared to levobupivacaine 0.5%.…”