Management of breakthrough pain during advanced labor with epidural alkalinized lidocaine 0.3%-epinephrine: a single-center retrospective study (2022-2026).

BACKGROUND

Breakthrough pain during advanced labor requires rapid analgesia while limiting motor block. We describe responses to epidural alkalinized lidocaine 0.3% with epinephrine 10 µg/mL.

METHODS

This single-center retrospective cohort included women receiving epidural alkalinized lidocaine 0.3%-epinephrine for breakthrough pain at cervical dilation of at least 7 cm after satisfactory neuraxial analgesia. Women with recurrent epidural boluses suggesting catheter dysfunction were excluded. Median bolus volume was 3 mL [interquartile range, 3-5]. The primary outcome was contraction-pain visual analog scale change from baseline to 5-15 min. Secondary outcomes included sensory and motor changes. Brackets indicate interquartile ranges. Paired assessments preceded delivery.

RESULTS

Of 153 women, 143 were analyzed. Median visual analog scale decreased from 50 [30-60] to 0 [0-0] mm (mean reduction, 45.2; 95% confidence interval, 41.9-48.4); 126 (88.1%) scored 10 mm or less. Median rescue-to-delivery interval was 52 min [31-88]. Median cephalad cold-loss extension was one dermatome [1-2]. Modified Bromage scores were unchanged in 138 (96.5%) and worsened in five (3.5%). Maternal hypotension and new fetal heart rate abnormalities each affected six women (4.2%). Among vaginal deliveries, operative delivery rates were 9.3 and 0.6 percentage points higher in nulliparous and parous women, respectively, than in same-period deliveries with neuraxial analgesia without the study rescue.

DISCUSSION: Epidural alkalinized lidocaine 0.3%-epinephrine (3-8 mL) was followed by early pain reduction with infrequent motor block increase, supporting clinical application of prior laboratory findings. Prospective comparisons should assess motor function and delivery outcomes.