Management of breakthrough pain during advanced labor with epidural alkalinized lidocaine 0.3%–epinephrine: a single-center retrospective study (2022–2026)
Authors' conclusion
Epidural alkalinized lidocaine 0.3%-epinephrine (3-8 mL) was followed by early pain reduction with infrequent motor block increase, supporting clinical application of prior laboratory findings. Prospective comparisons should assess motor function and delivery outcomes.
Study context
- Population
- Women receiving epidural alkalinized lidocaine 0.3%-epinephrine for breakthrough pain at cervical dilation of at least 7 cm after satisfactory neuraxial analgesia; women with recurrent epidural boluses suggesting catheter dysfunction excludedanalyzed, of 153 women
- Participants
- 143 women
- Outcome
- Contraction-pain visual analog scale change from baseline
- Follow-up
- 5-15 min
Main finding
As reported in the abstract
Epidural alkalinized lidocaine 0.3%-epinephrine
50 [30-60] to 0 [0-0]
median · mm
- Mean reduction
- 45.2; 95% confidence interval, 41.9-48.4
- Scored 10 mm or less
- 126 (88.1%)
Observational data: associations, not effects.
Secondary outcomes
Rescue-to-delivery interval
- Median rescue-to-delivery interval
- 52 min [31-88]
Cephalad cold-loss extension
- Median cephalad cold-loss extension
- one dermatome [1-2]
Modified Bromage scores
- Unchanged
- 138 (96.5%)
- Worsened
- five (3.5%)
Operative delivery rates among vaginal deliveries, vs same-period deliveries with neuraxial analgesia without the study rescue
- Nulliparous women, percentage points higher
- 9.3
- Parous women, percentage points higher
- 0.6
- Among vaginal deliveries
Safety
Maternal hypotension
- Maternal hypotension
- six women (4.2%)
New fetal heart rate abnormalities
- New fetal heart rate abnormalities
- six women (4.2%)
Original publication
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