Key result
Lidocaine 2% with bicarbonate provided the fastest onset of epidural anaesthesia for caesarean delivery, being 6.4 minutes faster (95% CrI 3.3-9.6) than bupivacaine 0.5%.
Why the study?
Rapid-onset epidural local anaesthesia can avoid general anaesthesia for caesarean delivery, motivating a ranking of the onset speed of commonly used epidural local anaesthetics.
Does the choice of local anaesthetic improve the speed of onset of epidural anaesthesia in women undergoing caesarean section?
Meta-Analysis (n=1,280)
Does the choice of local anaesthetic improve the speed of onset of epidural anaesthesia in women undergoing caesarean section?
Mean Difference: 6.4 (95% CI 3.3–9.6)
Lidocaine 2% with bicarbonate, 2-chloroprocaine 3%, and lidocaine 2% provide faster onset of epidural anaesthesia for caesarean section compared to bupivacaine 0.5%.
Supports lidocaine 2% with bicarbonate to hasten caesarean epidural onset; extends NMA rankings among local anaesthetics.
Rapid-onset epidural local anaesthesia can avoid general anaesthesia for caesarean delivery. We performed a Bayesian network meta-analysis of direct and indirect comparisons to rank speed of onset of the six local anaesthetics most often used epidurally for surgical anaesthesia for caesarean delivery. We searched Google Scholar, PubMed, EMBASE, Ovid, CINAHL and CENTRAL to June 2019. We analysed 24 randomised controlled trials with 1280 women. The mean (95%CrI) onset after bupivacaine 0.5% was 19.8 (17.3-22.4) min, compared with which the mean (95%CrI) speed of onset after lidocaine 2% with bicarbonate, 2-chloroprocaine 3% and lidocaine 2% was 6.4 (3.3-9.6) min faster, 5.7 (3.0-8.3) min faster and 3.9 (1.8-6.0) min faster, respectively. Speed of onset was similar to bupivacaine 0.5% after ropivacaine 0.75% and l-bupivacaine 0.5%: 1.6 (-1.4 to 4.8) min faster and 0.4 (-2.2 to 3.0) min faster, respectively. The rate (95%CrI) of intra-operative hypotension was least after l-bupivacaine 0.5%, 315 (236-407) per 1000, and highest after 2-chloroprocaine 3%, 516 (438-594) per 1000. The rate (CrI) of intra-operative supplementation of analgesia was least after ropivacaine 0.75% 48 (19-118) per 1000 and highest after 2-chloroprocaine 3%, 250 (112-569) per 1000.
No takes yet. Share an insight, caveat, or question.
Reschke et al. (2019) conducted a meta-analysis in Caesarean delivery (n=1,280). Lidocaine 2% with bicarbonate vs. Bupivacaine 0.5% was evaluated on Speed of onset of surgical anaesthesia (MD 6.4 min faster, 95% CI 3.3-9.6). Lidocaine 2% with bicarbonate provided the fastest onset of epidural anaesthesia for caesarean delivery, being 6.4 minutes faster (95% CrI 3.3-9.6) than bupivacaine 0.5%.
Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context: