Epidural lidocaine versus 2-chloroprocaine for fetal distress requiring urgent cesarean section

Chloroprocaine is a local anesthetic widely used for the urgent cesarean delivery of a distressed fetus in an mother with a epidural catheter because of its quick onset and short half-life. However, chloroprocaine has disadvantages that include decreased effectiveness of subsequently administered epidural amides and narcotics. Lidocaine with freshly added epinephrine and sodium bicarbonate is also rapid in onset, although there is the theoretical concern regarding the accumulation of ionized lidocain in the acidotic fetus. A retrospective review revealed that though the drug administration to incision time was significantly faster (P < 0.005) for 3% chloroprocaine, both 3% chloroprocaine and 1.5% lidocaine were clinically effective. There were no differences in neonatal Apgar scores or neonatal umbilical cord pH values between the two treatment populations, offering lidocaine as an attractive alternative to chloroprocaine.