Local anesthetics and opioids commonly used for epidural anesthesia for cesarean delivery

Drug	Dose	Duration of action^*
Local anesthetics
Lidocaine 2% with epinephrine 1:200,000	15 to 25 mL^¶	75 to 100 minutes
Chloroprocaine	15 to 25 mL	40 to 60 minutes
Opioids
Fentanyl	50 to 100 mcg	2 to 4 hours^Δ
Sufentanil	20 to 30 mcg	2 to 4 hours^Δ
Morphine	1.5 to 3 mg	5 to 30 hours, mean 19 hours
Hydromorphone	0.4 to 1 mg	10 to 20 hours

This table shows drugs that are commonly used for epidural anesthesia for CD. Bupivacaine and ropivacaine are rarely used because of slow onset and risk of local anesthetic systemic toxicity. For emergency CD, sodium bicarbonate (2 mL per 20 mL of local anesthetic) can be added to lidocaine or chloroprocaine to speed the onset. This table should be used in conjunction with UpToDate content on anesthesia for cesarean delivery.

CD: cesarean delivery; NSAIDs: nonsteroidal anti-inflammatory drugs.

* For local anesthetics, duration of action is defined as time to two spinal segment regression. For opioids, duration of action is usually defined as time to first request for analgesia.

¶ When dosing an epidural catheter for CD, local anesthetic should be titrated to effect.

For patients with a de novo epidural catheter placed for CD, up to 25 mL may be required.
For patients with an existing labor epidural, the required volume depends on the labor analgesia solution and recent epidural top ups. Required volume may be as low as 10 to 15 mL or as high as 20 mL.

Δ Duration of action of hydrophilic opioids varies widely and may depend on administration of systemic analgesics (eg, NSAIDs).

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Local anesthetics and opioids commonly used for epidural anesthesia for cesarean delivery