This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Roelants, F. Articles by Lavand’homme, P. M. Search for Related Content PubMed PubMed Citation Articles by Roelants, F. Articles by Lavand’homme, P. M. Related Collections Obstetrics Regional Anesthesia Pharmacology

---

OBSTETRIC ANESTHESIA

The Effect of a Lidocaine Test Dose on Analgesia and Mobility After an Epidural Combination of Neostigmine and Sufentanil in Early Labor

From the Department of Anesthesiology, Université Catholique de Louvain, St. Luc Hospital, Brussels, Belgium.

Address correspondence and reprint requests to P. Lavand’homme, MD, Department of Anesthesiology, St. Luc Hospital, Av Hippocrate 10-1821, 1200 Brussels, Belgium. Address e-mail to lavandhomme{at}anes.ucl.ac.be.

We previously demonstrated the effectiveness of epidural sufentanil and the cholinesterase inhibitor, neostigmine, to initiate selective labor analgesia. Because the traditional lidocaine plus epinephrine test dose (TD) may alter the effect of subsequent epidural drugs, we undertook this investigation to evaluate the impact of a lidocaine TD on analgesia from a combination of epidural neostigmine plus sufentanil administered in early labor. Eighty healthy parturients were randomly allocated to two groups to receive a 3 mL-TD, either lidocaine 2%–epinephrine (1:200,000) or saline–epinephrine (1:200,000), followed 3 min later by epidural neostigmine 500 µg plus sufentanil 10 µg. Pain scores were recorded for 30 min after injection, as was the time elapsed from initial bolus until request for supplemental analgesia. Thirty minutes after injection, adequacy of motor function was evaluated by the parturient’s ability to sit, stand up, bend her knees, and walk. Lidocaine TD hastened the onset (5 min vs 15 min) and increased duration (122 ± 53 min vs 98 ± 54 min; P = 0.02) of analgesia from epidural neostigmine plus sufentanil bolus. In contrast, the TD did not significantly impair the ability to sit, stand up, or bend the knees. The ability to ambulate, however, was reduced (57% vs 82%; P = 0.04). In conclusion, a traditional lidocaine TD significantly enhances the analgesic effect from the epidural neostigmine plus sufentanil combination, but affects ambulation in early labor.