Which statement is NOT correct when advising the surgeon to perform infiltration anesthesia for an emergency cesarean delivery when general and neuraxial anesthesias are contraindicated?

Which statement is NOT correct when advising the surgeon to perform infiltration anesthesia for an emergency cesarean delivery when general and neuraxial anesthesias are contraindicated?

• A. A midline incision is most desirable
• B. The rectus muscle should be injected to provide good skin analgesia
• C. The skin incision is the most painful part of the surgery
• D. Bupivacaine with bicarbonate is the local anesthetic of choice

Answer: (D)

When a cesarean must proceed without general or neuraxial anesthesia, you rely on a rapid, reliable field block by infiltrating the abdominal wall. The goal is to numb skin and the deeper tissues along the planned incision so the surgeon can proceed quickly and the patient remains comfortable. In this scenario, the skin and subcutaneous tissues are usually the most painful parts of the procedure, so thorough infiltration in that area is essential, and sometimes infiltration into the rectus sheath helps cover the deeper layers that will be incised. The statement about using bupivacaine with bicarbonate as the local anesthetic of choice isn’t correct for this urgent infiltrative approach. Bupivacaine has a slower onset compared with lidocaine, which is problematic when time is of the essence in an emergency. Lidocaine provides a faster onset, and adding bicarbonate can further speed onset and lessen injection discomfort. Bupivacaine also carries a higher risk of cardiotoxicity if large areas are infiltrated, which is a greater concern in an emergent situation where the dose and surface area may be substantial. For these reasons, lidocaine (often with bicarbonate) is favored over bupivacaine for this specific infiltrative technique.

When a cesarean must proceed without general or neuraxial anesthesia, you rely on a rapid, reliable field block by infiltrating the abdominal wall. The goal is to numb skin and the deeper tissues along the planned incision so the surgeon can proceed quickly and the patient remains comfortable. In this scenario, the skin and subcutaneous tissues are usually the most painful parts of the procedure, so thorough infiltration in that area is essential, and sometimes infiltration into the rectus sheath helps cover the deeper layers that will be incised.

The statement about using bupivacaine with bicarbonate as the local anesthetic of choice isn’t correct for this urgent infiltrative approach. Bupivacaine has a slower onset compared with lidocaine, which is problematic when time is of the essence in an emergency. Lidocaine provides a faster onset, and adding bicarbonate can further speed onset and lessen injection discomfort. Bupivacaine also carries a higher risk of cardiotoxicity if large areas are infiltrated, which is a greater concern in an emergent situation where the dose and surface area may be substantial. For these reasons, lidocaine (often with bicarbonate) is favored over bupivacaine for this specific infiltrative technique.