Medical Pharmacology Clinical Case: Local Anesthesia

Medical Pharmacology: Local Anesthetics Practice Questions

A 32 year-old primipara was admitted to the obstetrical floor during the first stage of labor.
In the third trimester of pregnancy, she experienced numerous extrasystoles, and one bout of bigeminy.
On admission, her ECG appear normal.
- However, her labor was progressing slowly, and a long-acting epidural block would be preferred.

case author: Hugh S. Mathewson, M.D., Professor Emeritus, School of Allied Health, Department of Nurse Anesthesia, University of Kansas Medical Center
case editor: Michael Gordon, Ph.D.

What local anesthetic would probably be the safest and most applicable for her epidural block?
1. lidocaine (Xylocaine)
2. etidocaine (Duranest)
3. chloroprocaine (Nesacaine)
4. ropivacaine (Naropin)
5. bupivacaine (Marcaine)
Ropivacaine (Naropin) is a homologue of bupivacaine (Marcaine)? Why is it less cardiotoxic?
1. lower dosages may be used
2. more rapidly metabolized
3. ropivacaine (Naropin) is marketed as the pure S-derivative; less cardiotoxicity compared to R-isomer
4. all of the above
Is ropivacaine (Naropin) has clinically effective as bupivacaine (Marcaine) for obstetrical anesthesia under epidural block?
1. yes
2. no

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