Transient Neurologic Symptoms After Anesthesia: A Lower Incidence with Prilocaine and Bupivacaine Than with Lidocaine

Hampl, Karl F.; Heinzmann-Wiedmer, Sidonie; Luginbuehl, Igor; Harms, Christoph; Seeberger, Manfred; Schneider, Markus; Drasner, Kenneth

doi:10.1097/00132586-199906000-00050

Cited by 34 publications

(60 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1 However, spinal bupivacaine has a longer duration of action than lidocaine. Thus, there is a reason for the interest in using small doses of bupivacaine in order to make this drug compatible with ambulatory surgery.…”

Section: Discussionmentioning

confidence: 99%

Onset of spinal block is more rapid with isobaric than hyperbaric bupivacaine

Martin

Frigon

Chretien

et al. 2000

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose: To compare isobaric with hyperbaric 9.75 mg bupivacaine injected intrathecally, and to evaluate the effects of subsequent injection of lidocaine 2% into the epidural space.Methods: Patients in group 1 (n=30) received isobaric 9.75 mg bupivacaine and in group 2 (n=30) hyperbaric 9.75 mg bupivacaine injected into the subarachnoid space in a combined spinal-epidural technique. They were undergoing urological, gynecological, orthopedic, gastro-intestinal or vascular surgery. Using a double blind technique, the followings parameters were measured: cutaneous analgesia to pinprick, motor blockade, time for two segment regression, time for complete regression of the motor block, quality of anesthesia. In 12 patients the effect of epidural injections of 3 ml lidocaine 2% was observed.Results: Motor and sensory block developed more rapidly (five minutes) in the isobaric group ( P < 0.05) . Maximum upper level (T7 ± 2 ), two-segment regression (52 min in both groups), motor recovery (160 vs 157 min), and quality of anesthesia did not differ between the two groups. Thirty nine epidural injections of 3 ml lidocaine 2% were given in 12 patients 10 min after spinal injection, 28 were in the hyperbaric group (P < 0.05). Twenty six of the epidural injections produced an increase in sensory block of 0 or 1 dermatome, and 13, of 2 or more. Conclusion:The block developed more rapidly in the isobaric group, but both isobaric and hyperbaric 9.75 mg bupivacaine produced adequate upper levels of analgesia for surgery. The effect of epidural injections of 3 ml lidocaine 2% was usually minimal.Objectif : Comparer 9,75 mg de bupivacaïne isobare et hyperbare injectés en sous-arachnoïdien, et évaluer l'effet, quand nécessaire, de la lidocaïne 2 % injectée subséquemment dans l'espace épidural.Méthode : Les patients du groupe 1 (n=30) ont reçu 9,75 mg de bupivacaïne isobare et ceux du groupe 2 (n=30) 9,75 mg de bupivacaïne hyperbare en injection sous-arachnoïdienne selon une technique combinée rachi-épidurale. Des interventions chirurgicales urologiques, gynécologiques, orthopédiques, gastro-intestinales et vasculaires ont été faites. En utilisant une technique de double insu, on a mesuré les paramètres suivants : analgésie cutanée à la piqûre, bloc moteur, temps de régression de 2 niveaux, temps de régression complète du bloc moteur, qualité d'anesthésie. Chez 12 patients qui ont eu besoin d'injections épidurales de 3 ml de lidocaïne 2 %, l'effet de l'injection a été observé.Résultats : Les blocs moteur et sensitif se sont développés plus rapidement (5 min) dans le groupe isobare (P < 0,05). Les niveaux supérieurs d'analgésie (D7 ± 2), les temps de régression de 2 segments (52 min), la récupération motrice (160 vs 157 min), et la qualité de l'anesthésie ont été similaires. Trente-neuf injections épidu-rales de 3 ml de lidocaïne 2 % ont été faites chez 12 patients, 10 min après l'injection sous-arachnoïdienne. Vingthuit des réinjections l'ont été dans le groupe hyperbare (P < 0,05); vingt-six ont produit une augmentation de 0 ou 1 de...

show abstract

Section: Discussionmentioning

confidence: 99%

Onset of spinal block is more rapid with isobaric than hyperbaric bupivacaine

Martin

Frigon

Chretien

et al. 2000

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

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

“…A natureza radicular bilateral da dor pode sugerir neurotoxicidade específica da lidocaína, porém o período livre de sintomas entre a regressão do bloqueio e o aparecimento da dor e a falta de sinais objetivos consistentes de neurotoxicidade fala contra neurotoxicidade 83 . Atualmente acredita-se que a lidocaína, porque determina maior relaxamento muscular, propicia estiramento múscu-lo-esquelético quando o paciente permanece em posição de litotomia no per-operatório 71,84 . Em estudo recente, com o objetivo de se determinar se os SNT eram resultado de neurotoxicidade direta da lidocaína, foram avaliados os pacientes que apresentavam SNT com auxílio de eletroneuromiografia, de estudos de condução nervosa e de potenciais evocados somatossensoriais e não foram observadas quaisquer alterações eletrofisiológicas em nenhum paciente, nem mesmo em áreas susceptíveis aos efeitos tóxicos dos anestésicos locais, como as raízes nervosas posteriores 85 .…”

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%

“…The bilateral radicular pain may suggest specific lidocaine neurotoxicity, but the period free of symptoms between blockade reversion and pain, and the lack of objective and consistent neurotoxicity signs talk against neurotoxicity 83 . Currently, it is believed that lidocaine, for determining more muscle relaxation, allows for musculoskeletal stretching when patients remain in perioperative lithotomy position 71,84 . In a recent study aiming at determining whether TNS was a result of direct lidocaine neurotoxicity, TNS patients were evaluated by electromyography, nervous conduction and somatosensory evoked potential and no electrophysiological changes were found, not even in areas susceptible to local anesthetic toxic effects, such as posterior nerve roots 85 .…”

Section: Transient Neurological Symptomsmentioning

confidence: 99%

See 2 more Smart Citations

Complicações neurológicas determinadas pela anestesia subaracnóidea

Ganem

Castiglia

Vianna

2002

Rev. Bras. Anestesiol.

View full text Add to dashboard Cite

show abstract

Vorübergehende neurologische Symptome nach einer Spinalanästhesie mit 4%igem hyperbarem Scandicain ® (Mepivacain)

Bang-Vojdanovski¹,

Hannibal²,

Eberhardt

2002

Der Anaesthesist

View full text Add to dashboard Cite

This is a case report of transient neurologic symptoms (TNS) after spinal anesthesia with 4% hyperbaric mepivacaine,which have not been reported before. The patient was a 44-year-old man with a meniscus lesion who received spinal anesthesia with 80 mg 4% mepivacaine while undergoing knee arthroscopy. A L3-L4 mid-line approach was used with a 26-gauge Quincke needle and a 21-gauge introducer. The local anaesthetic was injected over approximately 30 s with the aperture of the Quincke needle in a cephalad direction. A transient pain syndrome was observed 4 h after spinal anesthesia, which included symmetric pain and/or dysesthesia in the buttocks and posterior thighs appearing 4 h after recovery from the spinal anesthesia and had a duration of 2 days. The patient stated that the pain radiated through the hips, buttocks, and posterior thighs and extended past the buttocks and lower legs. The pain was described as strong and aching,occasionally decreasing when walking around. It responded well to NSAID and resolved spontaneously within 3 days. No other neurologic symptoms or signs were noted.

show abstract

Transient Neurologic Symptoms After Anesthesia: A Lower Incidence with Prilocaine and Bupivacaine Than with Lidocaine

Cited by 34 publications

References 0 publications

Onset of spinal block is more rapid with isobaric than hyperbaric bupivacaine

Onset of spinal block is more rapid with isobaric than hyperbaric bupivacaine

Complicações neurológicas determinadas pela anestesia subaracnóidea

Vorübergehende neurologische Symptome nach einer Spinalanästhesie mit 4%igem hyperbarem Scandicain ® (Mepivacain)

Contact Info

Product

Resources

About