Background and Aims Previous surveys have shown bupivacaine to be the most commonly used local anaesthetic for epidural extension,1,2 but meta-analyses have since shown it to be slower in onset and require more intraoperative supplementation.3,4 Furthermore, lidocaine has been associated with the fastest onset of blockade, and ropivacaine required the least intraoperative supplementation, and this may have further influenced practice.3,4
Methods In conjunction with the Obstetric Anaesthetists’ Association, we designed an electronic survey that was emailed to all their members between June and September 2020. In response, 430 surveys were completed, achieving a response rate of 23%.
Results Lidocaine was reported to be the most commonly administered local anaesthetic (41%), followed by levobupivacaine (17%), ropivacaine (15%), levobupivacaine with lidocaine (9%), bupivacaine (8%), and bupivacaine with lidocaine (8%).
Rationale for the selection of local anaesthetic included familiarity (82%), speed of onset (76%) and quality of block (67%).
Complications that have occurred subsequent to an epidural top up were: failed top up needing general anaesthesia (517); high spinal (109), 22 of whom required tracheal intubation; arrhythmia (31); allergic reaction (6); total spinal (5); local anaesthetic systemic toxicity (3); seizure (3); and cardiac arrest (2).
Conclusions Use of lidocaine and ropivacaine has increased since previous surveys, however bupivacaine continues to be commonly used despite evidence of inferiority in the literature. Rationale for individuals justifying the use of a chosen mixture may not necessarily reflect the latest evidence. The occurrence of complications serves as a reminder that we as anaesthetists should continue to be vigilant at all times.
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