OB PATIENT WITH ANAPHYLAXIS TO AMIDE LOCAL ANESTHETIC PRESENTING FOR A C-SECTION

Kenneth Hunt, MD, Anesthesiology Resident, University of Colorado School of Medicine

Parker Juels, MD Candidate 2027, University of Colorado School of Medicine

Alma Juels, MD, Associate Professor of Anesthesiology, University of Colorado School of Medicine, Denver Health and Hospital

 

Disclosures: The authors have no conflicts of interest to report.

A 30-year-old G1P0 presented  at 39 weeks for a C-section. The fetus was in a breech position, and the patient was refusing a version. The patient stated she had an anaphylactic reaction to Lidocaine at the dentist a few years back. She said she followed up with an allergist who confirmed her allergy to Lidocaine by skin test, per report, no other local anesthetics LA were tested. The patient was offered a general anesthetic, but she preferred a regional and wanted to know her options. The decision was made to offer her an epidural with 2-chloroprocaine. To rule out a potential allergy, we decided to do a skin test with the LA. The potential side effects of an epidural with 2-chloroprocaine were reviewed and we explained that a pre-procedure skin test would be warranted. Consent was obtained. We injected 0.5 cc of 2-chloroprocaine subcutaneously in her forearm. After 20 minutes, no reaction was noted, and we felt comfortable proceeding. The decision was made to do an epidural versus a single shot spinal due to the short duration of the  2-chloroprocaine. The usual duration of a chloroprocaine spinal is 20 to 30 minutes. A combined spinal epidural was considered but we wanted to make sure the epidural was working before proceeding. 3cc of 2-chloroprocaine were injected at the L3-L4 lumbar skin area. An epidural needle was then placed, advancing until loss of resistance, the catheter was threaded and the needle was removed. 12 cc of preservative-free 2-chloroprocaine was injected through the catheter. The patient had no sensation, per skin prick, up to T4. The patient was comfortable. The baby was delivered and had Apgar scores of 8 and 9. At 30 minutes the patient started complaining of some discomfort, 3 more cc of 2-chloroprocaine were injected in the epidural catheter and the case ended without issues. On follow up the patient had no side effects and was happy with her care.