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Canadian Journal of Anesthesia 52:887-888 (2005)
© Canadian Anesthesiologists' Society, 2005

Correspondence

Lidocaine 2% with or without glucose 8% for spinal anesthesia for short orthopedic surgery

Luiz Eduardo Imbelloni, MD and Lúcia Beato, MD

Clinica Sao Bernardo, Rio de Janeiro, Brazil, E-mail: dr.imbelloni{at}terra.com.br

To the Editor:

Because lidocaine spinal anesthesia has a relatively short duration of action when compared with bupivacaine and mepivacaine,1 abandoning lidocaine would leave a void in our regional anesthesia drug armamentarium. We have been using 2% isobaric and hyperbaric lidocaine since 1988, and our results differ from the majority of published works.

We studied 502 patients, ASA I–II aged from 20 to 60, receiving spinal anesthesia for short orthopedic surgery. Approval of the Ethical Committee of the hospital was obtained, all patients gave written informed consent and were randomly allocated into one of two groups: 3 mL lidocaine 2% heavy, or plain lidocaine 2%. Quincke needles 27G or 29G were used in the lateral position. We observed: latency of analgesia, motor block, duration, spread of analgesia, cardiovascular alterations, postdural puncture head-ache and transient neurologic symptoms (TNS). All patients spent the night after surgery in the hospital. They were all evaluated in the first postoperative day and were followed up by telephone. TNS was defined as pain or dysesthesia in the buttocks or in any part of the lower limbs, either isolated or associated with back pain after spinal anesthesia recovery and resolving within 72 hr. Anesthesia extension was compared by Mood’s test for medians. Frequencies were compared by Pearson’s Chi-squared test or by analysis of dependence in cases of low frequency events. The results are shown in the TableGo.


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The cause of TNS remains undefined, and has been speculated to be local anesthetic toxicity, needle trauma, neural ischemia secondary to sciatic stretching, patient positioning, pooling of local anesthetic agents secondary to maldistribution caused by pencil-point needles, glucose addition, muscle spasm, myofascial trigger points, early mobilization or irritation of dorsal ganglia. The low overall incidence of TNS in this study (2.8%) is likely related to the small dose of local anesthetic used.2 Our data also show that the type of surgery influences its incidence. Thirteen of the patients developing the symptoms were submitted to knee videoarthroscopy. The prevalence of TNS in videoarthroscopy was 10.5% in the heavy solution group and 3.6% in the plain solution group. These findings suggest that TNS correlates with the patient’s position on the operating table, and that lidocaine plus glucose increase the risk of TNS.

References

1 Pitkänen MT, Kalso EA, Rosenberg PH. Comparison of hyperbaric bupivacaine, lidocaine, and mepivacaine in spinal anesthesia. Reg Anesth 1984; 9: 175–82.

2 Morisaki H, Masuda J, Kaneko S, Matsushima M, Takeda J. Transient neurologic syndrome in one thousand forty-five patients after 3% lidocaine spinal anesthesia. Anesth Analg 1998; 86: 1023–6.[Abstract]





This Article
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