Volume 14, Issue 2 (Spring- In Press 2026)
Iran J Health Sci 2026, 14(2): 0-0 |
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Asdaghi Jahromi I, Faghani Makrani N, Babaei Nesami Z, Shabankhani K. Articaine for Cesarean Section: A Narrative Review of Its Potential Role in Spinal Anesthesia. Iran J Health Sci 2026; 14 (2)
URL: http://jhs.mazums.ac.ir/article-1-1087-en.html
URL: http://jhs.mazums.ac.ir/article-1-1087-en.html
Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. , kshabankhani@gmail.com
Abstract: (96 Views)
Background and Purpose: Articaine is a local anesthetic with rapid onset and dual metabolic pathways, making it a potential option for spinal anesthesia in cesarean delivery. However, evidence regarding its efficacy and safety in obstetric anesthesia remains limited. This review aims to summarize current knowledge and assess whether articaine may have a role in cesarean section anesthesia.
Materials and Methods: For this narrative review, a comprehensive literature search was conducted in PubMed, Embase, and Cochrane Library for the period 1995–2025. Eligible studies included clinical trials, pharmacokinetic investigations, and neurotoxicity assessments examining intrathecal or epidural administration of articaine in both obstetric and non-obstetric populations.
Results: Nine clinical trials and multiple pharmacologic studies were identified. Intrathecal articaine (60–84 mg, 5% hyperbaric) consistently produced surgical anesthesia within 3–5 minutes and maintained sensory block for 70–85 minutes, with earlier motor recovery and ambulation compared to bupivacaine. In obstetric populations, data—though limited—demonstrated reliable sensory levels, stable maternal blood pressure, and neonatal Apgar scores comparable to traditional agents. Pharmacokinetic findings revealed a rapid 20–30 minute plasma half-life due to ester hydrolysis, reducing systemic toxicity risk. No clinically significant neurotoxicity has been reported at cesarean-section doses, though high-dose animal studies indicate the need for ongoing vigilance.
Conclusion: Articaine combines fast onset, adequate intraoperative duration, and expedited maternal recovery, making it a promising alternative for spinal anesthesia in cesarean section. However, larger multicenter randomized trials are required to confirm obstetric safety, optimize dosing strategies, and evaluate long-term neonatal outcomes before widespread clinical adoption.
Materials and Methods: For this narrative review, a comprehensive literature search was conducted in PubMed, Embase, and Cochrane Library for the period 1995–2025. Eligible studies included clinical trials, pharmacokinetic investigations, and neurotoxicity assessments examining intrathecal or epidural administration of articaine in both obstetric and non-obstetric populations.
Results: Nine clinical trials and multiple pharmacologic studies were identified. Intrathecal articaine (60–84 mg, 5% hyperbaric) consistently produced surgical anesthesia within 3–5 minutes and maintained sensory block for 70–85 minutes, with earlier motor recovery and ambulation compared to bupivacaine. In obstetric populations, data—though limited—demonstrated reliable sensory levels, stable maternal blood pressure, and neonatal Apgar scores comparable to traditional agents. Pharmacokinetic findings revealed a rapid 20–30 minute plasma half-life due to ester hydrolysis, reducing systemic toxicity risk. No clinically significant neurotoxicity has been reported at cesarean-section doses, though high-dose animal studies indicate the need for ongoing vigilance.
Conclusion: Articaine combines fast onset, adequate intraoperative duration, and expedited maternal recovery, making it a promising alternative for spinal anesthesia in cesarean section. However, larger multicenter randomized trials are required to confirm obstetric safety, optimize dosing strategies, and evaluate long-term neonatal outcomes before widespread clinical adoption.
Keywords: Articaine, Cesarean section, Neuraxial block, Spinal anesthesia, Clinical Pharmacokinetics
Type of Study: Review Article |
Subject:
Maternal and Child Health
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