Extending labor epidural analgesia using lidocaine plus either dexmedetomidine or epinephrine for emergency cesarean section

Peer review under responsibility of Egyptian Society of Anesthesiologists.

Figures & data

able 1 Categorization of urgency of cesarean section [9].

	Grade definition done at time of decision to operate
Category 1	Immediate threat to life of mother or fetus as active bleeding, placental Abruption, uterine rupture, severe fetal distress
Category 2	Maternal or fetal compromise but not immediately life-threatening
Category 3	Need early delivery but no maternal or fetal compromise (a parturient who has booked for an elective cesarean section but goes into labor before her scheduled operation date)
Category 4	At a time that suits the patient and maternity team

igure 1 CONSORT flow diagram of the study groups.

able 2 Demographic and intraoperative data.

Parameters	Group LE (n = 30)	Group LD (n = 30)
Age (years)	28 ± 3	28 ± 1
Height (cm)	159 ± 4	159 ± 6
Weight (kg)	77 ± 7	76 ± 3
Gestational age (weeks)	39 ± 2	39 ± 2
Parity: Primigravida/multigravida	10/20	9/21
Duration of operation (min)	46 ± 11	47 ± 7
Intraoperative fluid (L)	3 ± 0	2 ± 0
Time to T4 (min)	10 ± 1	10 ± 0
Max block height	T3 (T1–T4)	T3 (T2–T4)
Time to maximum block (min)	12 ± 1	12 ± 1
Time to incision (min)	12 ± 1	12 ± 0.5
Time to delivery (min)	16.0 ± 1.0	15 ± 1
Patients requiring fentanyl supplementation (n)	11 (33.3%)^⁎	4 (13.3%)
Mean total fentanyl used (μg)	34 ± 13^⁎⁎	25 ± 0
Apgar score at 1 min	9 (8–10)	9 (8–10)
Apgar score at 5 min	10 (9–10)	10 (9–10)
Surgeon’s satisfaction	0/0/9/21	0/0/8/22

Data are presented as mean ± SD, number, median and range.

p value > 0.05 is insignificant.

#x204E; p value <0.05 in the LE (lidocaine epinephrine) group compared to LD (lidocaine dexmedetomidine) group.

#x204E;⁎ p value is <0.001 in the LE (lidocaine epinephrine) group compared to LD (lidocaine dexmedetomidine) group.

able 3 Data of pre-existing epidural analgesia.

Parameters	Group LE (n = 30)	Group LD (n = 30)
Duration of analgesia (h)	8 ± 1	8 ± 0
Pre-existing sensory level	T10 (T9–T12)	T10 (T8–T12)
Pre-existing motor level	0 (0–1)	0 (0–1)
Pre-existing VAS	2.5 (2–3)	2 (2–3)
Time since last top up (h)	3 ± 0.5	3 ± 0

Data are presented as mean ± SD, median and range.

LD: lidocaine dexmedetomidine, LE: lidocaine epinephrine. P value >0.05 is insignificant.

able 4 Degree of sedation.

Degree of sedation	Group LE (n = 30)	Group LD (n = 30)
Grade 0	19 (63.3%)	2 (6.7%)
Grade 1	8 (26.7%)	5 (16.7%)
Grade 2	3 (10%)	9 (30%)
Grade 3	0	14 (46.6%)
Grade 4	0	0
Grade 5	0	0

Data are presented as number of patients (%).

p value <0.001 in the overall degree of sedation between LD (lidocaine dexmedetomidine) group and LE (lidocaine epinephrine) group.

able 5 Incidence of side effects.

Parameters	Group LE (n = 30)	Group LD (n = 30)
Hypotension	3 (10%)	5 (16.6%)
Bradycardia	0	9 (30%)^⁎
Nausea, vomiting	3 (10%)	4 (13.3%)
Dizziness	0	0
Respiratory depression	0	0

Data are represented as number of patients (%).

#x204E; p value is significant (<0.001) in the LE (lidocaine epinephrine) group compared to LD (lidocaine dexmedetomidine) group.

able 6 Postoperative characteristics.

Parameters	Group LE (n = 30)	Group LD (n = 30)
Mean time to two segment regression (min)	151 ± 11	161.0 ± 9^⁎
Mean time to regression to Bromage 0 (min)	189 ± 11	210 ± 13^⁎
Mean time to 1st analgesic requirement (min)	210 ± 11	242 ± 7^⁎

Data are represented as mean ± SD.

#x204E; p value is significant <0.001 in the LE (lidocaine epinephrine) group compared to LD (lidocaine dexmedetomidine) group.