Procaine Compared With Lidocaine for Incidence of Transient Neurologic Symptoms

Hodgson, Peter S.; Liu, Spencer S.; Batra, Manbir S.; Gras, Troy W.; Pollock, Julia E.; Neal, Joseph M.

doi:10.1097/00115550-200005000-00002

Cited by 23 publications

(30 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Wie kann es möglich sein, dass eine Arbeitsgruppe [1] bei 100 Patientinnen der Lidocaingruppe nach Kaiserschnittentbindungen keine TNS beobachteten (das 95%-KI beträgt hier 0-4%), während in einer Reihe anderer Untersuchungen mit demselben Lokalanästhetikum (5%iges hyperbares Lidocain) durchweg eine deutlich höhere TNS-Inzidenz zwischen 25 und 34% beschrieben wurde [5,9,11,16,17,37]? Die Autoren der erstgenannten Untersuchung führen das Ausbleiben von TNS-Beschwerden auf einen protektiven Effekt der Schwangerschaft zurück und tatsächlich wurde in einer weiteren Untersuchung an Patientinnen, die sich einer postpartalen Tubenligatur in SPA -ebenfalls mit 5%igem hyperbarem Lidocain -unterzogen hatten, eine ebenfalls niedrige Inzidenz von 3,5% (1 von 29 Patientinnen) berichtet.…”

Section: Opioidzusatzunclassified

Transiente neurologische Symptome nach Spinalanästhesie Eine quantitative systematische Übersicht (Metaanalyse) randomisierter kontrollierter Studien

et al. 2002

View full text Add to dashboard Cite

show abstract

Section: Opioidzusatzunclassified

Transiente neurologische Symptome nach Spinalanästhesie Eine quantitative systematische Übersicht (Metaanalyse) randomisierter kontrollierter Studien

et al. 2002

View full text Add to dashboard Cite

show abstract

“…Risk of TNS with procaine (~ 6%) is less than with lidocaine but probably greater than with bupivacaine. 17 Prilocaine is approximately equipotent to lidocaine within a dose range of 40-70 mg 4 and thus may have suitable clinical characteristics for ambulatory spinal anesthesia (Table). Risk of TNS appears to be minimal with spinal prilocaine (0-1%).…”

Section: Hypnotic Effectsmentioning

confidence: 99%

Current issues in spinal anesthesia

Liu

2002

Can J Anesth/J Can Anesth

Self Cite

View full text Add to dashboard Cite

PINAL anesthesia is a venerable and simple technique. Technical competence is achieved early during training (> 90% technical success rate) after only 40-70 supervised attempts. 1 Although the ease and long history of spinal anesthesia may give the impression that it is an unsophisticated technique, much has been recently learned regarding the anatomy, physiology, pharmacology, and applications of spinal anesthesia.A An na at to om my y The arachnoid membrane is an important structure, as spinal agents must be delivered within its confines. The arachnoid membrane is composed of overlapping layers of epithelial cells connected by tight junctions. This anatomic arrangement allows the arachnoid membrane, not the dura, to function as the principal meningeal barrier (90% of resistance) to materials crossing in and out of the cerebrospinal fluid (CSF). The arachnoid membrane serves not only as a passive container of CSF but also actively processes and transports agents attempting to cross the meninges. Recent studies demonstrate that metabolic enzymes are expressed in the arachnoid membrane that can affect agents (e.g., epinephrine) and neurotransmitters important for spinal anesthesia (e.g., acetylcholine). 2 Active transport of compounds across the arachnoid membrane occurs in the area of the neural root cuffs where unidirectional transport of materials from the CSF into the epidural space occurs and may contribute to clearance of spinal anesthesia agents. After injection of spinal anesthetics, dilution with the CSF occurs prior to arrival at effector sites in the CNS. Thus, individual variation in lumbosacral volumes of CSF and distribution within this volume will affect spinal anesthesia. Recent imaging with magnetic resonance demonstrates great variability between individuals in volume of lumbosacral CSF with a range of 28-81 mL. Interestingly, obese individuals have substantially less CSF (~10 mL less) that is partly due to compression of the neural foramina. Clinical correlation between volume of lumbosacral CSF and spinal anesthesia with hyperbaric lidocaine and isobaric bupivacaine is excellent with CSF accounting for 80% of the variability for peak block height and regression of sensory and motor block. 3 Unfortunately, volume of lumbosacral CSF does not correlate with external physical measurements other than weight. Thus, CSF volume cannot be easily estimated from physical examination and is not easily applied to the clinical setting. 3 P Ph hy ys si io ol lo og gy y Cardiovascular The most common serious side effects from spinal anesthesia are hypotension and bradycardia, and closed claims surveys of 40,000-550,000 spinal anesthetics indicate an incidence of cardiac arrest from 0.04-10/10,000. 4,5 Large surveillance studies typically observed incidences of hypotension around 33% and bradycardia around 13% in non-obstetrical populations. 4 Risk factors for hypotension in non-obstetrical populations include block height $ T5, age $ 40 yr, baseline systolic blood pressure (SBP) < 120 mmHg, and spinal punctur...

show abstract

“…Apresenta incidência extremamente variável, dependendo do anestésico estudado e da posição em que o paciente permanece no per-operatório. A incidência é maior quando se utiliza a lidocaína [68][69][70][71][72] , quando comparada a outros anestési-cos locais, como bupivacaína 69 , assim como o tipo e o calibre da agulha 82 . Em estudo prospectivo multicêntrico envolvendo 1863 pacientes, observou-se que a lidocaína, a posição de litotomia e o paciente ambulatorial são fatores que prevêem para o aparecimento de SNT 82 .…”

Section: Síntomas Neurológicos Transitóriosunclassified

“…The incidence is higher with lidocaine [68][69][70][71][72] , as compared to other local anesthetics, such as bupivacaine 69 , prilocaine 71,73 and procaine 74 . Patients in perioperative lithotomy position have a 30% to 36% incidence of TNS 68,70,71 , patients remaining with bended knee for arthroscopy have an 18% to 22% incidence 69,72,75,76 , and patients in the supine position, between 4% and 8% 69,74 . Possible TNS causes are local anesthetic toxicity 65,77 , neural ischemia secondary to sciatic nerve stretching 66 , LA building up secondary to thin needles 78 , muscle spasm, myofacial triggering points 79 , early mobilization and dorsal root ganglia irritation 80 .…”

Section: Transient Neurological Symptomsmentioning

confidence: 99%