21 February 2009
The relationship between the efficacy of epidural anesthesia and the concentration of lidocaine in cerebrospinal fluid
Masayuki ArakawaABCDEF, Yoko OheADEGMed Sci Monit 2009; 15(3): CR95-100 :: ID: 869583
Abstract
Background
Addition of bicarbonate to local anesthetics improves the efficacy of epidural anesthesia. We evaluated whether the addition of bicarbonate to lidocaine enhanced pain threshold in cesarean section. We speculated that bicarbonate would increase the concentration of lidocaine in cerebrospinal fluid (CSF). To examine this possibility, we evaluated the relationship between the lidocaine concentration in the CSF and the pain threshold.
Material and Method
Twenty eight full-term parturients undergoing cesarean section under epidural anesthesia at L2-3 were divided into two groups: the first group (lidocaine group) received 17 mL of 2% lidocaine-epinephrine (1:200,000) and the second group (lidocaine-bicarbonate group) received the same concentration of lidocaine-epinephrine supplemented bicarbonate. Twenty min after administration of local anesthetics, we collected 1 mL samples of the CSF. The pain threshold after the repeated electrical stimulation was used to assess sensory blockade at the L2, S1, and S3 dermatomes.
Results
Demographic data were comparable between the groups. There were no differences in the pain threshold at all dermatomes and the lidocaine concentration between the groups. There was a significant correlation between the pain threshold and the lidocaine concentration at the combined S1 and S3 dermatomes in the lidocaine-bicarbonate group.
Conclusions
We find neither bicarbonate caused a significant difference in the efficacy of epidural anesthesia nor it caused an increase of lidocaine concentration in the CSF. The result that we found a significant correlation between the lidocaine concentration in the CSF and the pain threshold at the sacral region in the lidocaine bicarbonate group suggests that, bicarbonate enhances the efficacy of anesthesia at outside of spinal canal.
Keywords: Pregnancy, Pain Threshold - drug effects, Lidocaine - pharmacology, Anesthesia, Epidural
716 5
Editorial
01 November 2023 : Editorial
Editorial: Factors Driving New Variants of SARS-CoV-2, Immune Escape, and Resistance to Antiviral Treatments as the End of the COVID-19 Pandemic is DeclaredDOI: 10.12659/MSM.942960
Med Sci Monit 2023; 29:e942960
In Press
28 Nov 2023 : Clinical Research
Impact of Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography on Therapeutic Decisions and ...Med Sci Monit In Press; DOI: 10.12659/MSM.942122
28 Nov 2023 : Clinical Research
Long-Term Outcomes of Decompression and Grafting in Acute Pathological Proximal Femur Fractures in Children...Med Sci Monit In Press; DOI: 10.12659/MSM.943031
27 Nov 2023 : Clinical Research
Comparison of Outcomes from Emergency Admissions to a Major Trauma Center in Turkey of 1646 Elderly Patient...Med Sci Monit In Press; DOI: 10.12659/MSM.942916
27 Nov 2023 : Clinical Research
Evaluating Modified Ultrasound-Guided Serratus Anterior Plane Block for Enhanced Postoperative Recovery in ...Med Sci Monit In Press; DOI: 10.12659/MSM.942757
Most Viewed Current Articles
13 Nov 2021 : Clinical Research
Acceptance of COVID-19 Vaccination and Its Associated Factors Among Cancer Patients Attending the Oncology ...DOI :10.12659/MSM.932788
Med Sci Monit 2021; 27:e932788
30 Dec 2021 : Clinical Research
Retrospective Study of Outcomes and Hospitalization Rates of Patients in Italy with a Confirmed Diagnosis o...DOI :10.12659/MSM.935379
Med Sci Monit 2021; 27:e935379
14 Dec 2022 : Clinical Research
Prevalence and Variability of Allergen-Specific Immunoglobulin E in Patients with Elevated Tryptase LevelsDOI :10.12659/MSM.937990
Med Sci Monit 2022; 28:e937990
08 Mar 2022 : Review article
A Review of the Potential Roles of Antioxidant and Anti-Inflammatory Pharmacological Approaches for the Man...DOI :10.12659/MSM.936292
Med Sci Monit 2022; 28:e936292