Background and Goal of Study: The aim of the present randomised controlled study was to investigate the clinical efficacy and safety of 2-chloroprocaine 3% compared with levobupivacaine 0.5% for epidural anaesthesia during elective caesarean section. Levobupivacaine is routinely used for epidural anaesthesia during labor. However, when urgent caesarean section is needed in parturients who already have an epidural catheter, a rapid and an adequate extension of the epidural block to a surgical block is mandatory. Due to its rapid speed of onset, we hypothesized that 2-chloroprocaine could be a better choice in this setting. 
Methods: Fifty ASA I parturients scheduled for elective caesarean section delivery were planned to be randomly allocated by sealed envelope system to two groups: one group received 2-chloroprocaine 3% 13 ml, the other group received the same amount in ml levobupivacaine 0,5% after a test bolus of 3 ml was given. The addition of epidural sufentanil 10 µg augments epidural analgesia. Motor and sensory blockade were assessed every two minutes. Ethyl chloride spray allowed evaluation of both cold and light touch sensation. The speed of onset was defined as the time taken to loss of cold sensation at thoracic dermatome 4 (T4). 
Results and Discussion: Recruitment was stopped prematurely for safety reasons after including five parturients: two parturients were included in the levobupivacaine group, three in the chloroprocaine group. The onset time of 2-chloroprocaine 3% was 8, 10 and 10 minutes, for levobupivacaine 10 minutes for the first parturient and 20 minutes for the second after a 5 ml rescue bolus. Supplemental intravenous alfentanil was needed in all but one parturient (levobupivacaine group). Epidural anaesthesia was unsuccessful for surgery and needed conversion to general anaesthesia in two patients, one in both groups. 
Previous studies comparing 2-chloroprocaine with other anaesthetic solutions for epidural use were inconclusive and questioned its use for epidural surgical anaesthesia. In this study, the success rate was so poor that the study was stopped prematurely.
Conclusion: Based on the high failure rate, the use of 2-chloroprocaine 3% for neuraxial anaesthesia during caesarean section cannot be recommended.

05 / Comparison of 2-chloroprocaine 3% versus levobupivacaine 0.5% for neuraxial anaesthesia during caesarean section: a failed randomised controlled trial.