A Comparison of Minidose Lidocaine-Fentanyl and Conventional-Dose Lidocaine Spinal Anesthesia

Abstract

The syndrome of transient neurologic symptoms (TNS) after spinal lidocaine has been presumed to be a manifestation of local anesthetic neurotoxicity. Although TNS is not associated with either lidocaine concentration or dose, its incidence has never been examined with very small doses of spinal lidocaine. One hundred ten adult ASA physical status I and II patients presenting for arthroscopic surgery of the knee were randomly assigned to receive spinal anesthesia with either 1% hypobaric lidocaine 50 mg (Group L50) or 1% hypobaric lidocaine 20 mg + 25 microg fentanyl (Group L20/F25). Hemodynamic data, block height and regression, and time to first micturition and discharge were recorded. Follow-up phone calls were made by a blinded researcher at 48-72 h using a standardized questionnaire. Both groups had a median peak cephalad block level of T10. Lidocaine 50 mg was associated with a greater decrease in systolic blood pressure and a greater need for ephedrine. Time until block regression to the S2 dermatome (80 vs. 110 min) and outpatient time to void (130 vs 162 min) and discharge (145 vs. 180 min) were faster in the L20/F25 group. Complaints of TNS were found in 32.7% of the patients in the L50 group and in 3.6% of the patients in the L20/F25 group. We conclude that spinal anesthesia with lidocaine 20 mg + fentanyl 25 microg provided adequate anesthesia with greater hemodynamic stability and faster recovery than spinal anesthesia with lidocaine 50 mg. The incidence of TNS after spinal lidocaine 20 mg + fentanyl 25 microg was significantly less than that after spinal lidocaine 50 mg.

Neuraxial anesthesia and bladder dysfunction in the perioperative period: a systematic review

“…[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] In 41 studies (5,548 patients), urinary retention or PVR with intrathecal anesthesia was assessed (Table 3), 11,13,16,17,20,22, and in 39 studies (4,938 patients), urinary retention or PVR with epidural anesthesia and/or analgesia was assessed (Table 4). 28,33,35,43,[48][49][50]54, An additional five studies involved both intrathecal and epidural techniques.…”

“…45,64 In contrast, studies in which either intrathecal fentanyl or sufentanil was utilized reported lower incidence rates ranging from 0 to 25%. 12,16,18,46,48,57,61 Kamphuis et al…”

L’administration intrathécale de lidocaïne et de sufentanil diminue le temps de récupération après une opération du rectum en chirurgie ambulatoire

“…When these doses are used, the patients may experience intraoperative hypotension and high sensory and motor blocks resulting in a longer stay in the PACU than patients with a lower dose of lidocaine. 4 Also, larger doses of IT lidocaine [4][5][6] have been associated with transient neurological symptoms (TNS). Previous investigators 4,[7][8][9] have demonstrated the benefits of IT low-dose local anesthetics and opiates for ambulatory surgery including arthroscopy 8 and laparoscopy.…”

“…Other studies have also observed faster recovery after spinal anesthesia with lower doses of a local anesthetic agent and IT opioid. 4,[7][8][9] In addition, the time to discharge from the PACU 1 can be influenced by many factors (including waiting for transportation to the SDS unit from the PACU). Discharge time from the SDS unit can also be influenced by the arrival time of the patient's family or friend to take the patient home.…”

“…[4][5][6]20 TNS may be related to the total dose of IT lidocaine. Ben-David et al 4 reports that TNS was seen in 32.7% of patients who received 50 mg of IT lidocaine vs 3.6% of patients who received 20 mg IT lidocaine and 20 µg fentanyl. However, none of our patients showed any sign or symptom compatible with TNS.…”