Transient neurological symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics in adult surgical patients: a network meta-analysis

Abstract

Transient neurological symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics in adult surgical patients: a network meta-analysis.

Lidocaine vs. Other Local Anesthetics in the Development of Transient Neurologic Symptoms (TNS) Following Spinal Anesthesia: A Meta-Analysis of Randomized Controlled Trials

“…However, in this meta-analysis, more RCTs, including 39 studies with 4733 patients (more than twice) were analyzed and lidocaine was compared with more various local anesthetics. However, the risk ratio and prevalence of developing TNS of the current study was slightly lower than those of the previous studies; Zaric [3]. These difference can be explained in part by that many RCTs of the present meta-analysis reported no case of TNS in the lidocaine group [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18], and a continuity correction of 0.5 was applied to these zero total events trials to prevent the overestimation of the risk of TNS [21].…”

“…Since then, many RCTs have been still conducted to compare the incidence of TNS between lidocaine and other local anesthetics. A recent meta-analysis including 24 studies with 2226 patients compared the risk of TNS by using direct and indirect comparison [3]. However, in this meta-analysis, more RCTs, including 39 studies with 4733 patients (more than twice) were analyzed and lidocaine was compared with more various local anesthetics.…”

“…It offers a rapid onset and fast recovery of both motor and sensory block [1]. However, when compared with other local anesthetics, the use of lidocaine in spinal anesthesia has been known to be associated with increased risk of transient neurological symptoms (TNS) [2,3], hindering its application in ambulatory spinal anesthesia. Other local anesthetics including mepivacaine, low-dose bupivacaine, procaine, articaine, levobupivacaine, ropivacaine and 2-chloroprocaine have been suggested as replacement drugs.…”

“…TNS consists of pain in the lower extremities without abnormalities in neurologic and radiologic examination [2]. In previous systematic reviews and meta-analyses [2,3], lidocaine has a significantly higher relative risk of developing TNS compared with most other local anesthetics, but the previous meta-analyses lacked data on ropivacaine, levobupivacaine, and chloropocaine; thus, more evaluations…”

“…In the last decade, many randomized controlled trials (RCTs) comparing between the incidence of TNS after lidocaine and other local anesthetics have been conducted. More subsequent studies evaluating the effect of lidocaine on the risk of TNS have been published [2,3]. Furthermore, among them, many studies reported no patients suffering from TNS after spinal anesthesia with lidocaine [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18].…”