A randomised study of lidocaine and prilocaine for spinal anaesthesia

Abstract

TNS occurred also after isobaric prilocaine SA. The frequency was not significantly different from that following lidocaine SA but larger studies are needed to establish the relative risk of TNS following SA induced by the two local anaesthetics. Isobaric prilocaine has a longer duration of action than an equal dose of lidocaine and may be an alternative drug for spinal anaesthesia of intermediate or short duration.

Raquianestesia com dose baixa da combinação de bupivacaína e fentanil: uma boa alternativa para a cirurgia de ressecção transuretral de próstata em pacientes idosos em regime ambulatorial

“…The most popular local anesthetic in day case surgical patients is lidocaine but high incidence of TNS after intrathecal lidocaine led to the search for an alternative to lidocaine 5 . Prilocaine was reported as such in day case surgeries with low incidence of TNS [5][6][7] . However, marked hypotension and bradycardia were reported in intrathecal prilocaine use 7,16 .…”

“…Nonetheless, if used in conventional doses in day case surgeries, its main disadvantages are long duration of action and recovery and hemodynamic adverse effects like hypotension 8 . Many different attempts have been attempted to decrease the block duration of bupivacaine, like lowering the dose and adding adjuvant drugs 1,9,5,17,18 . Intrathecal opioids are known to enhance analgesia of subtherapeutic doses of local anesthetics 10,12,19 .…”

“…Prilocaine has a similar potency and duration of action to lidocaine 5,6 and also has been reported to have a lower incidence of TNS 5,7 . Also bupivacaine carries a low risk of TNS, but its long duration of action makes it unsuitable for day case surgery 8 .…”

“…Lidocaine was a popular local anesthetic for SA in day case surgical patients, but it's known to cause transient neurological symptoms (TNS) 4 , which is highly reported for patients having surgery in the litotomy position 5 . Prilocaine has a similar potency and duration of action to lidocaine 5,6 and also has been reported to have a lower incidence of TNS 5,7 .…”

Intrathecal hyperbaric 2% prilocaine versus 0.4% plain ropivacaine for same-day arthroscopic knee surgery: a prospective randomized double-blind controlled study

“…[10][11][12] The ideal spinal anesthetic for same-day surgery should provide rapid and adequate anesthesia for an appropriate duration, followed by rapid regression of sensory and motor blockade, rapid bladder voiding, and minimal residual effects to facilitate early ambulation. [13][14][15] Prilocaine is characterized by rapid onset and regression of sensory and motor blockade and a good safety profile, [16][17][18][19][20] while ropivacaine is a long-lasting local anesthetic. 21,22 Ratsch et al showed faster block recovery, which translated into faster discharge, 10 with the use of hyperbaric 2% prilocaine 60 mg vs hyperbaric 0.5% bupivacaine 15 mg for ambulatory spinal anesthesia.…”