Evaluation Of Lidocaine Combined With Fentanyl In Epidural Anesthesia For Cesarean Section

Objective To evaluate the effect and safety of lidocaine combined with fentanyl in epidural anesthesia for cesarean section by comparing epidural with subcutaneous administration of small dose of fentanyl.Methods Sixty ASA I parturients for cesarean section under epidural anesthesia were randomized into two groups: Epidural Fentanyl Group( EF,n=30 ) and Subcutaneous Fentanyl Group( SF,n=30). A test dose of 3ml of 2% lidocaine was administered to detect a correct epidural injetion. Five minutes later, the parturients in group EF received the epidural administration of 2% lidocaine 4 mL plus fentanyl 50μg (in NS 1 mL), accompanied by a subcutaneous injection of normal saline 1mL. The parturients in group SF received the epidural administration of 2% lidocaine 4 mL plus normal saline 1 mL, with a subcutaneous injection of fentanyl 50μg (in NS 1 mL). Supplimental bolus of 2% lidocaine 4～6 ml was injected epidurally every 3 min until a cephalad pain block(pin stick) to the eighth thoracic dermatome(T8) was achieved. Total lidocaine consumption, onset time of pain block to T10 and T8 dermatomes, corresponding Bromage Scores, side effects and Apgar scores of neonates were recorded. VAS scores were evaluated for satisfaction at epidural puncture(EP), skin incision(SI), peritoneum exploration(PE), neonate delivery(ND),suturing of the peritoneum(SP), and a overall intraoperative experience(OIV). Results Compared with group SF , total lidocaine consumption in group EF was 1.5ml less (18.2±0.9 ml vs 19.7±3.0 ml;P<0.05) ; Onset of sensory block to T10 and T8 dermatomes was significantly more rapid (T10 15.8±2.6 min vs 18.4± 3.2min;P<0.01; T8 19.6±3.6 min vs 23.8±5.1 min;P<0.01) ; VAS scores were lower in group EF (SP 0.0±0.0 vs 1.4±3.0; P<0.05; PE 0.0±0.2 vs 1.8±3.0; P<0.01; ND 0.1±0.4 vs 2.1±3.3; P<0.01; OIV 0.0±0.0 vs 1.8±2.7; P<0.01) . There was no difference in Bromage Scores, side effects and Apgar score of the neonates between the two groups.Conclusion Epidural fentanyl can minimize local anesthetic requirement,accelerate the onset of sensory block and provide more satisfactory intraoperative experience. Epidural injection of fentanyl is better than subcutaneous injection.