From January 1977 through July 1980, we used 2-chloroprocaine, 2% and 3% solutions, without epinephrine for epidural analgesia in 4,579 and 1,166 patients, respectively. No permanent neurological deficit was encountered during that period. From August 1980 through January 1981, closer follow-up was performed in all parturients receiving epidural analgesia: 1,417 received bupivacaine, followed by 2-chloroprocaine without epinephrine in 912 cases, 2% solution in 752 and 3% in 160. Of the 1,417 patients, six (0.4%) showed temporary neurologic complications: epidural bupivacaine had been injected in all six cases, followed by epidural 2-chloroprocaine 2% in four, subarachnoid lidocaine in one, and general anesthesia in one. The neurologic complications, lasting from a few days to one month, were mainly pain and numbness in the lower limbs, associated in two cases with motor weakness (mainly foot-drop). The possible causes for these complications could have been prolonged action of the local anesthetic drugs, physical injury of the nerves, or nerve compression during parturition. Recognized accidental dural puncture occurred in seven parturients (0.5%), five of whom received 2-chloroprocaine: other than post-lumbar-puncture cephalgia, no neurologic complications occurred. No permanent neurologic deficit, cauda equina lesion, or arachnoiditis developed during the study. In conclusion 2-chloroprocaine, in our experience, has been a safe drug for epidural analgesia in obstetrics.
- Epidural anesthesia
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Presented, in part, at the annual meeting of the American Society of Anesthesiologists, New Orleans, Louisiana, October 17‐21, 1981.
Address reprint requests to Dr. Abouleish: Department of Anesthesia, Magee‐Womens Hospital, Forbes Avenue and Halket Street, Pittsburgh, PA 15213.