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2-Chloroprocaine for local perineal infiltration
E H Philipson1, B R Kuhnert, C D Syracuse
1Perinatal Clinical Research Center, Cleveland Metropolitan General Hospital, Ohio 44109.
American Journal of Obstetrics and Gynecology
|November 1, 1987
Summary
2-Chloroprocaine offers a safer alternative for perineal anesthesia during childbirth compared to lidocaine. This local anesthetic shows minimal placental transfer, resulting in very low fetal exposure during episiotomy procedures.
Area of Science:
- Obstetrics and Gynecology
- Pharmacology
- Anesthesiology
Background:
- Lidocaine demonstrates significant placental transfer after perineal infiltration for episiotomy, leading to substantial fetal exposure.
- A local anesthetic with rapid metabolism and inactive metabolites is needed for safer perineal infiltration during childbirth.
Purpose of the Study:
- To evaluate the placental transfer of 2-chloroprocaine after local perineal infiltration for episiotomy.
Main Methods:
- 17 healthy term pregnant women received 2-chloroprocaine for episiotomy.
- Maternal and neonatal plasma/urine were analyzed for 2-chloroprocaine and its metabolite, chloroaminobenzoic acid.
Main Results:
- 2-Chloroprocaine was undetectable in maternal and umbilical cord plasma at delivery (trace in one cord).
- Neonatal plasma showed no detectable 2-chloroprocaine, but chloroaminobenzoic acid was present in maternal and cord plasma.
- Mean chloroaminobenzoic acid levels were 1.04 µg/ml in maternal plasma and 0.35 µg/ml in cord plasma.
Conclusions:
- 2-Chloroprocaine provides effective analgesia for episiotomy with minimal active drug transfer to the fetus.
- 2-Chloroprocaine is a preferable alternative to lidocaine for local perineal infiltration due to its favorable safety profile.