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Selective spinal anesthesia for outpatient laparoscopy. II: Epinephrine and spinal cord function

Himat Vaghadia, MB BS MHSC FCA FRCPC^*,, Michael A. Solylo, BSc MD FRCPC^*, Cynthia L. Henderson, MD FRCPC^* and G.W.E. Mitchell, MB CHB FRCOG FRCS(Ed) FRCSC

^* From the Departments of Anesthesia,
Health Care and Epidemiology, and
Gynaecology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.

Address correspondence to: Dr. Himat Vaghadia, The Department of Anesthesia (Room 3200), Vancouver General Hospital, 3rd Floor - 910 West 10th Ave, Vancouver, BC, V5Z 4E3 Canada. Phone: 604-875-4304; Fax: 604-875-5209; E-mail: hvaghadi{at}vanhosp.bc.ca

Purpose: To compare two small-dose solutions (with and without epinephrine) for spinal anesthesia during outpatient laparoscopy and to determine spinal cord function with these low-dose solutions.

Method: Twenty outpatients undergoing gynecological laparoscopy were randomly assigned to receive spinal anesthesia with one of two low dose solutions. Group LS- 10 mg lidocaine plus 10 µg sufentanil; Group LSE- 10 mg lidocaine plus 10 µg sufentanil plus epinephrine 50 µg. Solutions were diluted to three millilitres with sterile water for injection. A 27-gauge Whitacre needle was inserted at L _2-3 or L _3-4 in the sitting position. Operating conditions and spinal cord function (spinothalamic, dorsal column and motor) were assessed.

Results: Operating conditions were good - excellent in both groups. The incidence of shoulder tip discomfort, pruritus and nausea, and the amount of supplementation with alfentanil and midazolam was not different between groups. Most patients in both groups had preserved dorsal column function and normal motor power on arrival in PACU and were able to satisfy ‘walk out’ criteria. Recovery of pinprick sensation and discharge times were not different. Mild pruritus (VAS score # 5 ) was present in both groups.

Conclusion: For short duration laparoscopy, addition of 50 µg epinephrine to a small dose of spinal 10 mg lidocaine with 10 µg sufentanil did not provide additional benefit in terms of intraoperative analgesia or operating conditions. Spinal cord function was preserved with small-dose techniques.

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