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Anesth Analg 1983; 62:168-173
© 1983 International Anesthesia Research Society
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Comparison of Lidocaine and 2-Chloroprocaine in Paracervical Block

Clinical Effects and Drug Concentrations in Mother and Child

Robert R. Weiss, MD, Simon Halevy, MD, Rodolfo O. Almonte, MD, Kare Gundersen, MD, Orville N. Hinsvark, PhD, and James E. O'Brien

Departments of Obstetrics and Gynecology and Anesthesiology, Nassau County Medical Center, East Meadow, New York; the Health Sciences Center, State University of New York; and the Pharmaceutical Division, Pennwalt Corporation, Rochester, New York.

Abstract

2-Chloroprocaine (CP) has recently been recommended as a less toxic alternative to amide-type local anesthetics due to its rapid metabolism. A double-blind, randomized study comparing CP to lidocaine when used for paracervical block was carried out. Twenty-nine patients received CP, while 31 received lidocaine. None of the 60 mothers developed adverse side effects. Adequate pain relief was achieved in 28 cases in each group, with a mean duration of 40 min regardless of the anesthetic. No change in uterine activity was observed. In the CP group one fetus had mild bradycardia, while two in the lidocaine group had severe, and three mild bradycardia within 5–7 min after the block. Low concentrations of CP were detected in the venous blood of 2 of 29 mothers and in the umbilical venous blood of their babies. Measurable amounts of its metabolite, 2-chloro-4-aminobenzoic acid (CABA), were found in all 13 samples of maternal blood 5 min after PCB and in 6 of 27 maternal samples at birth. Traces of CABA were found in umbilical venous blood in three neonates; in a fourth, a level of 1,000 ng/ml was found. In contrast, unmetabolized lidocaine was found in all maternal samples and in all but one of the cord samples at birth. Concentration of lidocaine in cord blood at delivery ranged from <100 to 4,000 ng/ml and were similar for both arterial and venous samples. No correlation could be demonstrated between levels of local anesthetics in the cord samples and the frequency or severity of fetal bradycardia regardless of the anesthetic.

Key Words: ANESTHETICS, LOCAL: 2-chloroprocaine • ANESTHETIC TECHNIQUES: regional, paracervical • ANESTHESIA: obstetric






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1983 by the International Anesthesia Research Society.