Epidural anesthetics

[xtina0]

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Can anyone enlighten me to why lidocaine is given when introducing an epidural and then bupivicaine later on for an additional bolus?

Does is have to do with the half lives?

 

[Idiopathic]

there are many ways to dose an epidural. lidocaine is faster-acting but wears off quicker. it also seems to provide denser analgesia, which may not be advantageous in all settings (laboring women)

we use lidocaine in the test doses for recognition of inadvertent spinal catheter placement, which would be reliably reflected in a T7-T8 spinal with 45 mg lidocaine (or 3cc of a 1.5% test dose). if we dont see evidence of a spinal injection, then we feel more comfortable starting a bupivacaine infusion to provide analgesia, etc.

 

[partydoc]

Can anyone enlighten me to why lidocaine is given when introducing an epidural and then bupivicaine later on for an additional bolus?

Does is have to do with the half lives?

"A test dose is designed to detect both subarachnoid and intravascular injection. Typically a test dose consists of: 1.5% Lidocaine 3ml with 1:200,000 epinephrine. If intrathecal �a spinal anesthesia should be rapidly apparent. If intravascular �a 20% or more increase in heart rate should be noted."

http://www.pitt.edu/~regional/Epidural/epidural.htm

 

[xtina0]

Thanks a ton!!!