The Incidence of Transient Neurologic Symptoms After Spinal Anesthesia with Mepivacaine

Abstract

We prospectively evaluated 1273 patients who received spinal (or combined spinal-epidural [CSE]) anesthesia with 1.5% mepivacaine (plain, no glucose) for ambulatory surgery. We hypothesized that analysis of a large series of patients would confirm previous findings that isobaric 1.5% mepivacaine is not frequently associated with transient neurologic symptoms (TNS). Patients were contacted twice after the anesthetic, at days 1-4 and days 6-9. One-thousand-two-hundred-ten patients were successfully contacted postoperatively (95% follow-up rate). None of the patients had permanent neurologic sequelae from the anesthetic. None of the 372 CSE anesthetics was inadequate for surgery. Fourteen of 838 (1.7%) of the spinal anesthetics were inadequate. TNS, defined as the new onset of back pain that radiated bilaterally to buttocks or distally, occurred in 78 patients (6.4%; 95% confidence intervals 5.1%-8%). The mean age of patients who developed TNS (48 +/- 14 yr) was older than that of patients without TNS (41 +/- 16 yr) (P < 0.001). TNS was not influenced by gender or intraoperative position. The frequent success rate and infrequent rates of complications such as TNS and postdural puncture headache suggest that spinal anesthesia with mepivacaine is likely to be a safe and effective anesthetic for ambulatory patients.

Anesthetic and recovery profiles of lidocaine versus mepivacaine for spinal anesthesia in patients undergoing outpatient orthopedic arthroscopic procedures

“…Our current study extended the data collection time points to 48 and 72 hours but still did not report a patient with TNS. YaDeau et al's [14] prospective cohort study showed an overall incidence of TNS using 1.5% mepivacaine to be 6.4%; however, they noted only a 1.8% incidence of TNS among ACL reconstruction patients and were unable to explain the difference. They also found an association with age and TNS, where the average age of TNS patients was 48 ± 14 yrs versus 41 ± 16 yrs in non-TNS patients [14].…”

“…Transient neurologic symptoms were defined as back pain or dysesthesia that radiated to the buttocks, thighs, hips or calves, using the criteria of Pollock et al [6]. Isolated back pain with point tenderness, nonradiating back pain, exacerbation of preexisting back pain, new pain in the extremities not associated with back pain, or pain at the spinal needle site was not considered to be TNS [14]. Demographic data and anesthetic and recovery parameters were compared using analysis of variance, t-test, and Pearson Chi-square analysis.…”

“…Another study using isobaric mepivacaine 20 mg/mL and isobaric lidocaine 20 mg/mL resulted in an incidence of TNS at 7.5% and 2.5%, respectively, for patients having orthopedic procedures in the supine position [13]. In addition, a large cohort study of 1,273 patients showed that the incidence of TNS was 6.4% using 1.5% mepivacaine for ambulatory spinal anesthesia [14].…”

Mépivacaïne rachidienne additionnée de fentanyl pour une arthroscopie du genou en ambulatoire: une étude randomisée contrôlée

“…In the largest observational trial to date involving 1,273 patients, the incidence of TNS with 1.5% isobaric mepivacaine was 6.4%. 31 Results from smaller randomized blinded trials have demonstrated rates of TNS ranging from 0 to 7.4%. 10,18,32,33 Reported risk factors for the development of TNS include outpatient status, obesity, lithotomy, and knee arthroscopy position.…”

Regional anesthesia techniques for ambulatory orthopedic surgery

“…Mepivacaine provides another option with rapid onset and relatively short duration of action; however, TNSs have been associated with 4% hyperbaric mepivacaine [20]. YaDeau et al [21] studied isobaric 1.5% mepivacaine in patients undergoing orthopedic lower limb surgery. Intrathecal doses of 45-50 mg produced excellent anesthesia for lower limb procedures of less than 90 min duration with combined spinal epidural (CSE) techniques preferred for surgery of longer than 90 min expected duration.…”