Abstract
Objective: Due to its fast onset of action, 2% lidocaine is our local anaesthetic of choice for topping-up an already established epidural catheter in case of urgent Caesarean Section. Unfortunately, 2% lidocain is only available in 2-ml ampoules in the Czech Republic, and the time needed for drawing up the epidural bolus can be a barrier for its use in emergency.
Pre-filled syringes of lidocaine would significantly shorten the time from decision to administration in this situation as well as the overall time of onset of epidural anaesthesia. The general local protocols are mostly against this method, pointing to a risk of bacterial contamination of pre-drawn drugs.
Our study had the objective to evaluate the sterility and safety of the pre-filled lidocaine syringe, ready for immediate use in the obstetric theatre. Design: Observational, prospective study.
Setting: Obstetric operating theatre. Materials and methods: In total, 59 samples of lidocaine 2%, which were sterilely drawn up from 2-ml ampoules to a 20-ml syringe and closed with a sterile cap, were left on the anaesthetic trolley for 48 hours, and then tested for sterility.
Results: Microbial or fungal growth was found in none of the 59 pre-filled syringes of 2% lidocaine. All the samples were assessed as suitable from the sterility point of view.
Conclusion: Local anaesthetics have their own antimicrobial activity against a broad spectrum of pathogens. A sterilely pre-filled lidocaine syringe remains safe for use for at least 48 hours.
Pre-filling lidocaine for epidural top-up of anaesthesia for the Caesarean Section is rational and safe in terms of sterility.