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Continuous 2-Chloroprocaine Infusion versus Intermittent Bolus Injections of Bupivacaine or 2-Chloroprocaine for Epidural Anesthesia in Cesarean Delivery
  1. Oscar A. de Leon-Casasola, M.D.*,
  2. Naseera Syed, M.D.,
  3. Mark J. Lema, PH.D., M.D.** and
  4. Lawrence Emrich, PH.D.
  1. *Instructor in Anesthesia, State University of New York at Buffalo; Attending Anesthesiologist, Roswell Park Cancer Institute, Buffalo
  2. **Head, Department of Anesthesiology and Critical Care Medicine, Roswell Park Cancer Institute; Director of Anesthesia Research, State University of New York at Buffalo
  3. Director, Department of Biomathematics, Roswell Park Cancer Institute
  4. Clinical Assistant Professor, Director of Obstetric Anesthesia, Children's Hospital of Buffalo


A continuous infusion of 2-chloroprocaine (Group C) was compared with intermittent bolus injections of bupivacaine (Group B) or 2-chloroprocaine (Group N) for epidural anesthesia in cesarean delivery. Sixty-six patients scheduled for elective cesarean delivery were studied retrospectively during a three-month period. Maternal and neonatal demographics; cord pH; Apgar scores; duration of surgery, including times from induction, incision and end of the case; fluid requirements in the operating room and recovery room; amount of ephedrine used; blood pressures; duration of analgesia, and meperidine use via patient-controlled analgesia (PCA) up to 48 hours postpartum were recorded. Group B experienced a significantly longer time from loading dose to incision and a longer duration of analgesia, but twice the duration of recovery room care than either of the 2-chloroprocaine (2CP) groups. In the first six hours after surgery, Group N patients required significantly more PCA injections than patients in either Group B or Group C. Although statistically significant changes were detected in blood pressure values at three intervals, no clinical importance was appreciated. Fluid requirements were also greater for patients in Group B, both intraoperatively and in the post-anesthesia care unit. Epidural anesthesia using continuous 2CP infusion appears to combine the beneficial effects of bolus injections of both bupivacaine and 2CP by reducing recovery room stay and PCA requirements without troublesome side effects.

  • 2-Chloroprocaine
  • bupivacaine
  • local anesthetics
  • continuous infusion
  • epidural anesthesia
  • cesarean delivery

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