Addition of Lidocaine to Ropivacaine and Sufentanil for Epidural Labour Analgesia: A Randomised Double-Blind Study on the Incidence of Epidural-Related Maternal Fever.

BACKGROUND

Epidural-related maternal fever (ERMF) is a common complication of labour analgesia. In vitro evidence suggests ropivacaine provokes inflammatory cytokine release, while lidocaine may exert anti-inflammatory effects. We hypothesized that the addition of lidocaine to a ropivacaine-based epidural solution would reduce the incidence of ERMF.

METHODS

In this randomised, double-blind trial, 400 parturients received epidural analgesia with 0.075% ropivacaine and 0.5 μg/mL sufentanil, with or without 0.5% lidocaine. The primary outcome was the incidence of ERMF (tympanic temperature ≥38.0°C).

RESULTS

ERMF incidence was significantly lower in the lidocaine group (14.1%) than in the control group (28.3%), with an absolute risk reduction of 14.2% (95% CI: 5.6-22.7; P=0.0013). No significant differences were found in maternal antibiotic use or neonatal sepsis evaluations.

CONCLUSION

The addition of lidocaine to ropivacaine for epidural labour analgesia significantly reduced the incidence of ERMF. This finding suggests a simple and promising strategy for preventing this common complication, warranting further investigation into its mechanisms and clinical utility.