![]() ![]() 8 If allergy to lidocaine is true, bupivacaine cannot be used as it is also an amide group local anesthetic and has cross-reactivity with lidocaine 2 though the exact rate is not known. 8 A detailed history should be elicited for true allergic reactions like rashes, bronchospasm, urticarial, angioedema, and cardiovascular collapse. First is a careful history as symptoms like palpitations, vasovagal attacks, and anxiety during the IV injections can be mistaken for allergic reactions by the patient. If allergy to local anesthetic is reported it is very important to evaluate it further pre-conception or early in pregnancy. 8 Allergic reaction is commonly triggered by preservative methylparaben, para-aminobenzoic acid which is a metabolite of the amide group of local anesthetics, or ester or amide component. 4–7 True allergy to local anesthetic is not common. 1, 2 With intravenous opioid-based analgesia marred with lesser pain relief and a higher rate of adverse effects. The patient was comfortable with the intermittent boluses of nalbuphine, and she delivered a healthy baby after ten hours.Įpidural anesthesia is considered the best modality for labor analgesia. After an hour, the Ob team treated her with intermittent doses of Stadol (nalbuphine). After a total of 30 mL was infused PCEA was discontinued. However, the patient reported severe back spasm, which she described as burning pain deep in the muscles and was not willing for the continuation of epidural boluses of chloroprocaine. The epidural catheter placement was done and a pump for patient-controlled epidural analgesia (PCEA) at a basal rate of 12 mL/hr of chloroprocaine 1.5%+ fentanyl 2mcg/mL with optional boluses of 5 mL every 20 minutes was started. The code cart was kept in the room, and the obstetric team was made aware. The patient decided to proceed with the epidural analgesia using chloroprocaine for pain relief, after discussing the options available. ![]() She had reassuring airway, cardiac, liver, lung, and kidney functions. She reported a history of swelling of the throat on lidocaine gargle years prior. Our patient was advised to visit an allergist six months post-delivery.Ī 36-year-old G2P1 parturient with a history of gastroesophageal reflux disease with the fetus in a cephalic presentation in an active phase of labor requested labor analgesia. Mother and baby were discharged home on the third postpartum day. She was comfortable, with no symptoms of allergic reactions, and had a spontaneous vaginal delivery, after eight hours without issues. She was closely monitored for any symptoms of allergic reactions. ![]() A pump for patient-controlled epidural analgesia (PCEA) at a basal rate of 12 mL/hr of chloroprocaine 1.5%+ fentanyl 2mcg/mL with optional boluses of 5 mL every 20 minutes was started. The epidural catheter placement was performed easily, and 8 mL of chloroprocaine 1.5% was used as a loading dose. We performed skin testing with 0.1 mL of chloroprocaine subcutaneously, followed by 0.5mL and 1 mL of the same, no allergic reactions were noted, and the vital signs were stable 2 mL of chloroprocaine 1.5% (Nescaine MPF) was used to numb the skin. The obstetric team was made aware to be on standby if anaphylaxis occurred and stat delivery of the fetus was necessary. Standard ASA monitors were applied, an 18G IV was placed, and the patient was prepared for the procedure with the code cart in the labor room. The patient opted for chloroprocaine PCEA after understanding the risks and the benefits. We discussed at length the possible pain relief modalities including the risk and benefits of chloroprocaine PCEA and remifentanil intravenous (IV) patient-controlled analgesia (PCA). Though direct challenge can be tried with non-proven local anesthetic allergy, 4 or skin testing, it was not planned considering the risk for the mother and the baby in case of anaphylaxis. She did not remember the exact details of allergic reaction as it “occurred in childhood”. A 25-year-old G2P1 parturient with no major co-morbidity except for the history of lidocaine allergy in childhood presented to our hospital with 37 weeks’ gestation in an active phase of labor. ![]()
0 Comments
Leave a Reply. |