Abstract
The use of lidocaine in spinal anesthesia may increase the risk of transient neurological symptoms (TNS) according to previous meta-analyses. However, the previous meta-analyses lacked data on some other local anesthetics and thus, more evaluations are still needed to compare the effect of lidocaine on the development of TNS. The objective of this study was to compare the risk of TNS according to lidocaine versus other local anesthetics in patients undergoing spinal anesthesia. A total of 39 randomized controlled trials with 4733 patients were analyzed. The incidence of TNS was 10.8% in the lidocaine group and was 2.2% in the control groups (risk ratio (RR) 4.12, 95% confidence interval (CI) 3.13 to 5.43, p < 0.001). In subgroup analysis, lidocaine increased the incidence of TNS compared with other local anesthetics except mepivacaine, ropivacaine or sameridine. The risk of TNS was higher in the hyperbaric (p < 0.001) or isobaric lidocaine (p < 0.001) group compared with the control group, but there were no differences found between the two groups when hypobaric lidocaine was administered (p = 1.00). This study confirmed that lidocaine for spinal anesthesia still causes TNS more frequently than most other local anesthetics, especially when hyperbaric or isobaric lidocaine was used.
Highlights
Lidocaine is an attractive regional anesthetic for ambulatory surgery
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
We found that 28 randomized controlled trials (RCTs) had two groups [4,5,6,7,8,9,10,11,12,14,15,18, 23,26,27,29,30,34,35,36,37,38,39,40,41,42,44,46] of lidocaine more than other local anesthetics, while 11 RCTs had multiple groups [13,16,17,24,25,28,31,32,33,43,45]
Summary
Lidocaine is an attractive regional anesthetic for ambulatory surgery. It offers a rapid onset and fast recovery of both motor and sensory block [1]. 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. 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]. The objective of this systematic review and meta-analysis is to compare the incidence of TNS between lidocaine and other local anesthetics and to evaluate the frequency of TNS with various types of local anesthetics in adult surgical patients after spinal anesthesia
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