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Pulmonary function changes during epidural anesthesia for cesarean delivery

E Yun1, G P Topulos, S C Body

  • 1Department of Anesthesia, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA.

Anesthesia and Analgesia
|April 1, 1996
PubMed
Summary
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Lidocaine epidural anesthesia for cesarean delivery significantly decreased peak expiratory pressure (PEP) more than bupivacaine. This suggests anesthetic choice impacts respiratory mechanics in parturients.

Area of Science:

  • Anesthesiology
  • Pulmonary Medicine
  • Obstetrics

Background:

  • Pulmonary function changes in parturients are known, but the impact of regional anesthesia is unclear.
  • Epidural anesthesia is common for cesarean delivery, utilizing local anesthetics like bupivacaine and lidocaine.
  • Understanding anesthetic effects on respiratory function is crucial, especially for patients with compromised breathing.

Purpose of the Study:

  • To compare the effects of bupivacaine and lidocaine epidural anesthesia on pulmonary function tests in parturients undergoing cesarean delivery.
  • To investigate if different local anesthetics influence respiratory mechanics differently during regional anesthesia.

Main Methods:

  • Nineteen healthy parturients received either 0.5% bupivacaine or 2% lidocaine with epinephrine epidurally in a double-blind, randomized manner.

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  • Pulmonary function tests, including peak expiratory pressure (PEP), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1), were measured using spirometry.
  • Measurements were taken before and after epidural placement at specific spinal levels (T-10 and T-4).

    • Main Results:

    • No significant differences in peak inspiratory pressure, FEV1/FVC, FEV1, FVC, or peak expiratory flow rate were observed between the groups.
    • Patients receiving lidocaine demonstrated a significantly greater reduction in peak expiratory pressure (PEP) at both T-10 and T-4 levels compared to bupivacaine.
    • The greater decrease in PEP with lidocaine suggests a more pronounced effect on abdominal musculature, likely due to a denser motor block.

    Conclusions:

    • Lidocaine, compared to bupivacaine, caused a more significant decrease in peak expiratory pressure during epidural anesthesia for cesarean delivery.
    • The choice of local anesthetic may influence respiratory mechanics, particularly in parturients with pre-existing respiratory compromise.
    • These findings have implications for selecting epidural anesthetics in specific obstetric populations.