Hostname: page-component-77c89778f8-sh8wx Total loading time: 0 Render date: 2024-07-17T02:03:44.175Z Has data issue: false hasContentIssue false
  • English
  • Français

Combination of hyperbaric lidocaine and ropivacaine in spinal anaesthesia for day surgery

Published online by Cambridge University Press:  01 March 2006

H. Kallio ,
E.-V. T. Snäll ,
C. A. Tuomas  and
P. H. Rosenberg
H. Kallio
Affiliation:
Helsinki University Central Hospital, Department of Anaesthesiology and Intensive Care Medicine, Helsinki, Finland Forssa Hospital, Department of Anaesthesiology, Forssa, Finland
E.-V. T. Snäll
Affiliation:
Forssa Hospital, Department of Anaesthesiology, Forssa, Finland
C. A. Tuomas
Affiliation:
Forssa Hospital, Department of Anaesthesiology, Forssa, Finland
P. H. Rosenberg
Affiliation:
Helsinki University Central Hospital, Department of Anaesthesiology and Intensive Care Medicine, Helsinki, Finland
Get access

Extract

Summary

Background and objective: Motor function recovers rapidly but the extended duration of sensory block after spinal anaesthesia with hyperbaric ropivacaine may delay patients' ambulation after surgery. We tested whether compensating a reduction of the ropivacaine dose with a small dose of lidocaine would be adequate for surgery and shorten recovery from spinal anaesthesia. Methods: Fifty-six consecutive outpatients, who were scheduled for lower extremity surgery under spinal anaesthesia, were randomized into two groups to receive either a hyperbaric solution of lidocaine 20 mg and ropivacaine 5 mg (Group LR) or hyperbaric ropivacaine 10 mg (Group R). Sensory block was tested with pinprick and motor block on the Bromage scale at 5-min intervals until 30 min, then at 15-min intervals until 90 min, and thereafter at 30-min intervals until full bilateral recovery. Blinded interviews were performed on the first and seventh postoperative day. Results: The groups did not differ significantly regarding success of sensory block reaching T10 dermatome on the operative side, 24 (86%) in Group LR and 23 (82%) in Group R, median (range) onset time 5 (5–20) vs. 10 (5–25) min or median duration of T10 sensory block 68 (5–115) vs. 50 (20–115) min, respectively. Two patients in each group required general anaesthesia. Recovery did not differ between the groups, median time of full motor recovery was 75 min in both groups, sensory recovery of S2 2.5 h vs. 2.8 h, first voluntary micturition 4.2 (2.2–6.1) vs. 4.5 (2.4–6.6) h in the LR vs. R Group, respectively. Transient neurological symptoms did not appear. Conclusion: It is concluded that spinal anaesthesia with hyperbaric lidocaine 20 mg + ropivacaine 5 mg and hyperbaric ropivacaine 10 mg was quite similar regarding frequency, onset, duration of T10 dermatome sensory block and recovery. The patients would have been ready for discharge after voluntary micturition, 4.2–4.5 h from the subarachnoid injection of local anaesthetics.

Keywords

ANAESTHESIA, SPINALSURGERY, AMBULATORYANAESTHETICS LOCAL, ropivacaine, lidocaine
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 7 , July 2006 , pp. 568 - 573
Copyright
© 2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented in part as a poster at Annual Meeting of the American Society of Anesthesiologists 2005 October 24th, Atlanta, USA.

References

McDonald SB, Liu SS, Kopacz DJ, Stephenson CA. Hyperbaric spinal ropivacaine: a comparison to bupivacaine in volunteers. Anesthesiology 1999; 90: 971–977.Google Scholar
Khaw KS, Ngan Kee WD, Wong M, Ng F, Lee A. Spinal ropivacaine for cesarean delivery: a comparison of hyperbaric and plain solutions. Anesth Analg 2002; 94: 680–685.Google Scholar
Kallio H, Snäll E-VT, Tuomas CA, Rosenberg PH. Comparison of hyperbaric and plain ropivacaine 15 mg in spinal anaesthesia for lower limb surgery. Br J Anaesth 2004; 93: 664–669.Google Scholar
Fettes PD, Hocking G, Peterson MK, Luck JF, Wildsmith JA. Comparison of plain and hyperbaric solutions of ropivacaine for spinal anaesthesia. Br J Anaesth 2005; 94: 107–111.Google Scholar
Kallio H, Snäll E-VT, Suvanto SJ et al. Spinal hyperbaric ropivacaine-fentanyl for day-surgery. Reg Anesth Pain Med 2005; 30: 48–54.Google Scholar
McLeod GA. Density of spinal anaesthetic solutions of bupivacaine, levobupivacaine, and ropivacaine with and without dextrose. Br J Anaesth 2004; 92: 547–551.Google Scholar
Ben-David B, Maryanovsky M, Gurevitch A et al. A comparison of minidose lidocaine-fentanyl and conventional-dose lidocaine spinal anesthesia. Anesth Analg 2000; 91: 865–870.Google Scholar
Zaric D, Christiansen C, Pace NL, Punjasawadwong Y. Transient neurologic symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics. Cochrane Database System Review, Update 25-February-2004.
Casati A, Moizo E, Marchetti C, Vinciguerra F. A prospective, randomized, double-blind comparison of unilateral spinal anesthesia with hyperbaric bupivacaine, ropivacaine, or levobupivacaine for inguinal herniorrhaphy. Anesth Analg 2004; 99: 1387–1392.Google Scholar
Borghi B, Stagni F, Bugamelli S et al. Unilateral spinal block for outpatient knee arthroscopy: a dose-finding study. J Clin Anesth 2003; 15: 351–356.Google Scholar
Casati A, Fanelli G, Cappelleri G et al. Effects of spinal needle type on lateral distribution of 0.5% hyperbaric bupivacaine. Anesth Analg 1998; 87: 355–359.Google Scholar
Kaya M, Oguz S, Aslan K, Kadiogullari N. A low-dose bupivacaine: a comparison of hyperbaric and hypobaric solutions for unilateral spinal anesthesia. Reg Anesth Pain Med 2004; 29: 17–22.Google Scholar
McClellan KJ, Faulds D. Ropivacaine: an update of its use in regional anaesthesia. Drugs 2000; 60: 1065–1093.Google Scholar
Whiteside JB, Burke D, Wildsmith JAW. Comparison of ropivacaine 0.5% (in glucose 5%) with bupivacaine 0.5% (in glucose 8%) for spinal anaesthesia for elective surgery. Br J Anaesth 2003; 90: 304–308.Google Scholar
Mulroy MF, Salinas FV, Larkin KL, Polissar NL. Ambulatory surgery patients may be discharged before voiding after short-acting spinal and epidural anesthesia. Anesthesiology 2002; 97: 315–319.Google Scholar
Hampl KF, Schneider MC, Pargger H, Gut J, Drewe J, Drasner K. A similar incidence of transient neurologic symptoms after spinal anesthesia with 2% and 5% lidocaine. Anesth Analg 1996; 83: 1051–1054.Google Scholar
Buckenmaier CC III, Nielsen KC, Pietrobon R et al. Small-dose intrathecal lidocaine versus ropivacaine for anorectal surgery in an ambulatory setting. Anesth Analg 2002; 95: 1253–1257.Google Scholar
Pollock JE, Mulroy MF, Bent E, Polissar NL. A comparison of two regional anesthetic techniques for outpatient knee arthroscopy. Anesth Analg 2003; 97: 397–401.Google Scholar