Pregnancy Increases Median Nerve Susceptibility to Lidocaine

Abstract

To determine whether pregnancy renders women more sensitive to local anesthetics, nine nonpregnant and nine pregnant (third trimester) women underwent median nerve block at the wrist using 1% lidocaine HCl. Inhibition of median nerve A alpha sensory and motor fibers was assessed using measurements of sensory nerve action potential (SNAP) amplitude and compound motor action potential (CMAP) amplitude, respectively. Inhibition of median nerve C fibers was assessed by the increase in skin temperature and by the decrease in median (relative to ulnar) galvanic skin potential (GSP) amplitude. Lidocaine inhibited SNAP to a greater extent in pregnant than nonpregnant women at all time points (P = 0.019). CMAP declined differently in the pregnant and nonpregnant groups (P = 0.01): the pregnant subjects achieved steady state inhibition before the nonpregnant subjects. The two groups developed comparable steady state inhibition. Skin temperature was higher in pregnant women at all time points (P less than 0.0001); moreover, the increased skin temperature of pregnant women differed from that of the nonpregnant women (P = 0.037), reflecting a more rapid temperature increase in the pregnant women. GSP amplitude declined to 50% of control more rapidly in pregnant (mean = 4 min) than nonpregnant women (mean = 11.5 min), but these differences did not achieve statistical significance. It is concluded that pregnancy increases median nerve susceptibility to lidocaine.