Dosage finding for low‐dose spinal anaesthesia using hyperbaric prilocaine in patients undergoing perianal outpatient surgery

Gebhardt, Volker; Herold, Alexander; Weiß, Christel; Samakas, A.; Schmittner, Marc D.

doi:10.1111/aas.12031

Cited by 30 publications

(17 citation statements)

References 24 publications

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“…Step 3: Ibuprofen 800 mg po + Metamizol 2 g iv +Piritramide 7.5 mg iv 3 0 rate and supports previous findings of other authors [12,13,17,18]. Despite these findings, the application of small doses hyperbaric local anaesthetics is discussed controversially [19].…”

Section: Prilocaine (N=80)supporting

confidence: 76%

“…We minimized this bias by instructing a study nurse to test the block height and apply analgesics in the PACU. In a former trial, our research group investigated hyperbaric prilocaine 20 mg/ml for perianal outpatient surgery and found 10mg the preferable dosage, representing a volume of 0.5 ml [17]. Hyperbaric mepivacaine is commercially available only in a concentration of 40mg/ml.…”

Section: Prilocaine (N=80)mentioning

confidence: 99%

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Spinal hyperbaric prilocaine vs. mepivacaine in perianal outpatient surgery

Gebhardt

Beilstein

Herold³

et al. 2014

Open Medicine

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Section: Prilocaine (N=80)supporting

confidence: 76%

Section: Prilocaine (N=80)mentioning

confidence: 99%

Spinal hyperbaric prilocaine vs. mepivacaine in perianal outpatient surgery

Gebhardt

Beilstein

Herold³

et al. 2014

Open Medicine

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“…A sample size of 25 per group was required to detect at least a 30-minute difference (SD = 35.2) in S3 regression time and a 45-minute difference (SD = 38.9) in S1 regression time with a power of 90% at the 5% significance level. The differences of 30 minutes and 45 minutes were taken from literature [ 12 , 18 ]. The primary outcome variables were the sensory block resolution to S3 block and time to home readiness.…”

Section: Methodsmentioning

confidence: 99%

Spinal Anaesthesia with Hyperbaric Prilocaine in Day-Case Perianal Surgery: Randomised Controlled Trial

Kaban

Yazicioglu

Akkaya

et al. 2014

The Scientific World Journal

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Background. The local anaesthetics used in day-case spinal anaesthesia should provide short recovery times. We aimed to compare hyperbaric prilocaine and bupivacaine in terms of sensory block resolution and time to home readiness in day-case spinal anaesthesia. Methods. Fifty patients undergoing perianal surgery were randomized into two groups. The bupivacaine-fentanyl group (Group B) received 7.5 mg, 0.5% hyperbaric bupivacaine + 20 μg fentanyl in total 1.9 mL. The prilocaine-fentanyl group (Group P) received 30 mg, 0.5% hyperbaric prilocaine + 20 μg fentanyl in the same volume. Results. Time to L1 block and maximum block was shorter in Group P than in Group B (Group P 4.6 ± 1.3 min versus Group B 5.9 ± 01.9 min, P = 0.017, and Group P 13.2 ± 7.5 min versus Group B 15.3 ± 6.6 min, P = 0.04). The time to L1 regression and S3 regression of the sensorial block was significantly shorter in Group P than in Group B (45.7 ± 21.9 min versus 59.7 ± 20.9 min, P = 0.024, and 133.8 ± 41.4 min versus 200.4 ± 64.8 min, P < 0.001). The mean time to home readiness was shorter for Group P than for Group B (155 ± 100.2 min versus 207.2 ± 62.7 min (P < 0.001)). Conclusion. Day-case spinal anaesthesia with hyperbaric prilocaine + fentanyl is superior to hyperbaric bupivacaine in terms of earlier sensory block resolution and home readiness and the surgical conditions are comparable for perianal surgery.

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“…If a saddle block is required, 10e20 mg of hyperbaric prilocaine 2% administered in the sitting position is effective, reducing adverse cardiovascular effects and enabling rapid postoperative mobilisation. 25 Hyperbaric bupivacaine can be used if prilocaine is not available. Discharge may not be delayed if lower limb motor and sensory functions are not affected.…”

Section: Neurotoxicity and Nerve Injurymentioning

confidence: 99%

Spinal anaesthesia for ambulatory surgery

2019

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Explain the historical context of spinal anaesthesia in the ambulatory setting. Describe the ideal characteristics of an ambulatory spinal anaesthetic. Recognise the central role of prilocaine and 2chloroprocaine in the ambulatory setting. Select the right drug for the right patient and the right procedure. Ambulatory surgery places high demands on anaesthetic technique. In this setting, rapid onset and offset of anaesthesia, rapid recovery of protective reflexes, mobility and micturition, and good control of postoperative pain and nausea are required. Since the inception of ambulatory surgery, the favoured anaesthetic technique has been general anaesthesia with short-acting drugs. Concerns about the time to perform spinal anaesthesia and the risks of prolonged motor block and urinary retention have limited its use. Whilst in the UK, 'ambulatory surgery' refers solely to patients being discharged from the hospital shortly after surgery, in the USA this term may also apply to admissions for up to 23 h. In this article, we will consider ambulatory surgery to mean that the patient is discharged home before midnight on the day of surgery. Spinal anaesthesia has become increasingly popular for inpatient surgery, but, until recently, its use has been limited in ambulatory surgery by the lack of a safe, licensed short-acting local anaesthetic agent. An ideal intrathecal agent for ambulatory surgery should have a rapid onset of motor and sensory blockade, predictable regression within an acceptable time frame, and a low incidence of adverse effects. Historically, lidocaine was the preferred agent in this setting, providing a dense block with rapid recovery, but the identification of a high incidence of transient neurologic symptoms (TNS) has effectively excluded it from use. 1,2 Until recently, the only local anaesthetic preparations licensed for intrathecal use have been hyperbaric William Rattenberry FRCA is a specialty trainee in anaesthesia whose interests include quality improvement and regional anaesthesia.

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Dosage finding for low‐dose spinal anaesthesia using hyperbaric prilocaine in patients undergoing perianal outpatient surgery

Abstract: Hyperbaric prilocaine 20 mg/ml can be applied in dosages of 10, 20 and 30 mg for SPA in perianal surgery. Because of sufficient analgesia, missing motor block and shorter recovery times, 10 mg of hyperbaric prilocaine 20 mg/ml can be recommended for perianal outpatient surgery.

Cited by 30 publications

References 24 publications

Spinal hyperbaric prilocaine vs. mepivacaine in perianal outpatient surgery

Spinal hyperbaric prilocaine vs. mepivacaine in perianal outpatient surgery

Spinal Anaesthesia with Hyperbaric Prilocaine in Day-Case Perianal Surgery: Randomised Controlled Trial

Spinal anaesthesia for ambulatory surgery

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