Intraperitoneal chloroprocaine is a useful adjunct to neuraxial block during cesarean delivery: a case series

Background: Use of intraperitoneal local anesthetic to treat intraoperative pain during cesarean delivery has not been described previously. The aim of this study was to determine if intraperitoneal chloroprocaine may be useful as an adjunct to neuraxial block in reducing the proportion of patients with severe intraoperative pain that requires conversion to general anesthesia. Intraperitoneal chloroprocaine was administered during cesarean delivery as a potential alternative, when the anesthesiologist considered performing a general anesthetic due to severe intraoperative pain. Methods: A keyword search for “chloroprocaine” was performed for patients on labor and delivery between November 2013 and March 2017. Patients were included if cesarean delivery was initiated with neuraxial anesthesia and there was documented intraoperative intraperitoneal instillation of chloroprocaine. Results: Among 2479 patients who had cesarean delivery with neuraxial anesthesia, 32 received intraperitoneal chloroprocaine (mean dose 11.8 mg/kg). No patients exhibited signs of local anesthetic systemic toxicity or required conversion to general anesthesia. Among the 32 patients who received chloroprocaine, 17 had improved pain scores documented after instillation. Conclusion: Intraperitoneal chloroprocaine may be useful as part of a multimodal approach to managing intraoperative pain during cesarean delivery.