Lidocaine Spinal Anesthesia Research Articles

Efficacy of Spinal Epidural Anesthesia and Sub Diaphragmatic Lidocaine with Spinal Anesthesia in reduction of shoulder pain: Randomized Clinical trial

To determine the efficacy of spinal anesthesia with sub diaphragmatic lidocaine for gynecological laparoscopic surgery at the commencement of the procedure to spinal anesthesia for get pain relief Methods: It was a randomized clinical trial conducted at Ali Medical Hospital in Islamabad. A total of 84 patients were given sub diaphragmatic lidocaine spinal anesthesia, only spinal epidural anesthesia and general anesthesia. During procedure, 2, 4, 6 and 12 hours after surgery, and before discharge, patients' pain perception was measured using Visual Analogue Scale (VAS) Results: Outcomes showed no significant difference in perception of pain at different time intervals in all three groups. (F 4, 77 = 0.38, p = 0.81). At all-time intervals following surgery, patients' pain levels were similar between groups (F 2, 77 = 0.53, p = 0.57). Conclusions: The use of sub diaphragmatic lidocaine at the onset of surgery together with the spinal anesthesia did not result in a prominent statistical difference in patients' postoperative VAS scores when compared to general anesthesia and spinal epidural anesthesia after and prenatal invasive techniques.

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

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.

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

Spinal anaesthesia has been implicated as one of the possible causes of neurological complications following surgical procedures. This painful condition, occurringduring the immediate postoperative period, is termed transient neurological symptoms (TNS) and is typically observed after the use of spinal lidocaine. Alternatives to lidocaine that can provide high-quality anaesthesia without TNS development are needed. This review was originally published in 2005, and last updated in 2009. To determine the frequency of TNS after spinal anaesthesia with lidocaine and compare it with other types of local anaesthetics by performing a meta-analysis for all pair-wise comparisons, and conducting network meta-analysis (NMA) to rank interventions. We searched CENTRAL, MEDLINE, Elsevier Embase, and LILACS on 25 November 2018. We searched clinical trial registries and handsearched the reference lists of trials and review articles. We included randomized and quasi-randomized controlled trials comparing the frequency of TNS after spinal anaesthesia with lidocaine to other local anaesthetics. Studies had to have two or more armsthat used distinct local anaesthetics (irrespective of the concentration and baricity of the solution) for spinal anaesthesia in preparation for surgery. We included adults who received spinal anaesthesia and considered all pregnant participants as a subgroup. The follow-up period for TNS was at least 24 hours. Four review authors independently assessed studies for inclusion. Three review authors independently evaluated the quality of the relevant studies and extracted the data from the included studies. We performed meta-analysis for all pair-wise comparisons of local anaesthetics, as well as NMA. We used an inverse variance weighting for summary statistics and a random-effects model as we expected methodological and clinical heterogeneity across the included studies resulting in varying effect sizes between studies of pair-wise comparisons. The NMA used all included studies based on a graph theoretical approach within a frequentist framework. Finally, we ranked the competing treatments by P scores. The analysis included 24 trials reporting on 2226 participants of whom 239 developed TNS. Two studies are awaiting classification and one is ongoing. Included studies mostly had unclear to high risk of bias. The NMA included 24 studies and eight different local anaesthetics; the number of pair-wise comparisons was 32 and the number of different pair-wise comparisons was 11. This analysis showed that, compared to lidocaine, the risk ratio (RR)of TNS waslower for bupivacaine, levobupivacaine, prilocaine, procaine, and ropivacaine with RRs in the range of 0.10 to 0.23 while 2-chloroprocaine and mepivacaine did not differ in terms of RR of TNS development compared to lidocaine. Pair-wise meta-analysis showed that compared with lidocaine, most local anaesthetics were associated with a reduced risk of TNS development (except 2-chloroprocaine and mepivacaine) (bupivacaine: RR 0.16, 95% confidence interval (CI) 0.09 to 0.28; 12 studies; moderate-quality evidence; 2-chloroprocaine: RR 0.09, 95% CI 0.01 to 1.51; 2 studies; low-quality evidence; levobupivacaine: RR 0.13, 95% CI 0.02 to 0.69; 2 studies; low-quality evidence; mepivacaine: RR 1.01, 95% CI 0.18 to 5.82; 4 studies; very low-quality evidence; prilocaine: RR 0.18, 95% CI 0.07 to 0.49; 4 studies; moderate-quality evidence; procaine: RR 0.14, 95% CI 0.04 to 0.52; 2 studies; moderate-quality evidence; ropivacaine: RR 0.10, 95% CI 0.01 to 0.78; 2 studies; low-quality evidence). We were unable to perform any of our planned subgroup analyses due to the low numberof TNS events. Results from both NMA and pair-wise meta-analysis indicate that the risk of developing TNS after spinal anaesthesia is lower when bupivacaine, levobupivacaine, prilocaine, procaine, and ropivacaine are used compared tolidocaine. The use of 2-chloroprocaine and mepivacaine had a similar risk to lidocaine in terms of TNS development after spinal anaesthesia. Patients should be informed of TNS as a possible adverse effect of local anaesthesia with lidocaine and the choice of anaesthetic agent should be based on the specific clinical context and parameters such as the expected duration of the procedure and the quality of anaesthesia. Due to the very low- to moderate-quality evidence (GRADE), future research efforts in this field are required to assess alternatives to lidocaine that would be able to provide high-quality anaesthesia without TNS development. The two studies awaiting classification and one ongoing study may alter the conclusions of the review once assessed.

Neuropathy following spinal nerve injury shares features with the irritable nociceptor phenotype: A back-translational study of oxcarbazepine.

BackgroundThe term ‘irritable nociceptor’ was coined to describe neuropathic patients characterized by evoked hypersensitivity and preservation of primary afferent fibres. Oxcarbazepine is largely ineffectual in an overall patient population, but has clear efficacy in a subgroup with the irritable nociceptor profile. We examine whether neuropathy in rats induced by spinal nerve injury shares overlapping pharmacological sensitivity with the irritable nociceptor phenotype using drugs that target sodium channels.Methods In vivo electrophysiology was performed in anaesthetized spinal nerve ligated (SNL) and sham‐operated rats to record from wide dynamic range (WDR) neurones in the ventral posterolateral thalamus (VPL) and dorsal horn.ResultsIn neuropathic rats, spontaneous activity in the VPL was substantially attenuated by spinal lidocaine, an effect that was absent in sham rats. The former measure was in part dependent on ongoing peripheral activity as intraplantar lidocaine also reduced aberrant spontaneous thalamic firing. Systemic oxcarbazepine had no effect on wind‐up of dorsal horn neurones in sham and SNL rats. However, in SNL rats, oxcarbazepine markedly inhibited punctate mechanical‐, dynamic brush‐ and cold‐evoked neuronal responses in the VPL and dorsal horn, with minimal effects on heat‐evoked responses. In addition, oxcarbazepine inhibited spontaneous activity in the VPL. Intraplantar injection of the active metabolite licarbazepine replicated the effects of systemic oxcarbazepine, supporting a peripheral locus of action.ConclusionsWe provide evidence that ongoing activity in primary afferent fibres drives spontaneous thalamic firing after spinal nerve injury and that oxcarbazepine through a peripheral mechanism exhibits modality‐selective inhibitory effects on sensory neuronal processing.SignificanceThe inhibitory effects of lidocaine and oxcarbazepine in this rat model of neuropathy resemble the clinical observations in the irritable nociceptor patient subgroup and support a mechanism‐based rationale for bench‐to‐bedside translation when screening novel drugs.

Effect of oral tizanidine on prolongation of intrathecal lidocaine

Objective: In order to prolong the duration of intrathecal lidocaine, various drugs are used along with it. Due to the promising effects of tizanidine on central nervous system, it can be assumed that tizanidine can have a positive effect on increasing the anesthesia duration too. Thus, we aimed to investigate the effect of oral tizanidine on the duration of lidocaine spinal anesthesia. Methods: This double blind clinical trial was conducted on 40 male patients waiting for elective leg surgery with the age range of 20-60 years in one of the educational hospitals of Kerman University of Medical Sciences, Iran. We used simple random sampling and our participants were assigned into 2 groups (placebo and oral tizanidine receivers). Spinal anesthesia with 1 mg/kg of hyperbaric lidocaine 5% was performed in both groups. In tizanidine group, patients received 4 mg of oral tizanidine one hour before spinal anesthesia. Sensory block was examined by pin prick test and all anesthetic duration including start block until reduction of sensory level was calculated at 2 lower dermatomes. Results: Findings showed that oral tizanidine compared to placebo can cause a 10-15 minute increase in patients’ lidocaine spinal anesthesia. Therefore, the average anesthesia time for tizanidine group increased meaningfully (P = 0.03). In addition, tizanidine can sedate patients during surgery (P = 0.00) or in recovery (P = 0.003). Conclusion: Based on the results, tizanidine increased the duration of lidocaine so oral tizanidine can be used to prolong the duration of lidocaine spinal anesthesia.

Single-dose lidocaine spinal anesthesia in hip and knee arthroplasty.

BackgroundWith the increasing interest in fast recovery and outpatient joint arthroplasty, short-acting local anesthetic agents and minimal narcotic use are preferred. Lidocaine is a fast-onset, short-duration local anesthetic that has been used for many years in spinal anesthesia. However, lidocaine spinal anesthesia has been reported to have a risk of transient neurologic symptoms (TNSs). The purpose of this study is to determine the safety and efficacy of single-dose lidocaine spinal anesthesia in the setting of outpatient joint arthroplasty.MethodsWe performed a prospective study on 50 patients who received lidocaine spinal anesthesia in the setting of outpatient hip and knee arthroplasty. All patients received a single-shot spinal injection, with 2% isobaric lidocaine along with titrated propofol sedation. We evaluated demographic data, length of motor blockage, time to ambulation, time to discharge readiness, patient-reported symptoms of TNS.ResultsOf the 50 patients studied, 11 had total hip arthroplasty, 33 total knee arthroplasty, 5 unicompartmental knee arthroplasty, and 1 underwent isolated polyethylene liner exchange in a total knee arthroplasty. The average total duration of motor blockade was 2.89 hours (range 1.73-5.17, standard deviation 0.65). Average time from postanesthesia care unit to return of motor function was 0.58 hours (range 0-1.5, standard deviation 0.48). None of the patients reported TNS.ConclusionsIsobaric lidocaine spinal anesthesia appears to be a safe and effective regimen for outpatient hip and knee arthroplasty. All patients were discharged on the day of surgery with isobaric lidocaine spinal injection. There were no reports of TNSs.

Ephedrine Shows Synergistic Motor Blockade When Combined with Bupivacaine or Lidocaine for Spinal Anesthesia in a Rat Model

Ephedrine is a direct/indirect vasoactive drug. In addition, it also possesses intrinsic local anesthetic properties, mainly due to its sodium-channel blockage. We investigated whether ephedrine demonstrates a synergistic effect with bupivacaine and lidocaine when injected via a spinal catheter into the spinal space of rats. Spinal catheters were surgically placed in 47 rats (n = 8 per group; 7 rats were excluded.) Bupivacaine, lidocaine, and ephedrine in various concentrations and constant volumes (60 μL) were injected into the spinal catheters to determine the equipotency of each drug. Ephedrine in combination with either bupivacaine or lidocaine was then injected into the spinal catheters. Ephedrine demonstrated statistically significant synergistic effects with bupivacaine as well as with lidocaine in fixed combinations. The combination index reflecting a synergistic effect was 0.792 (95% confidence interval: 0.665-0.919) for ephedrine + bupivacaine and 0.663 (95% confidence interval: 0.532-0.794) for ephedrine + lidocaine. Ephedrine combined with either bupivacaine or lidocaine acted synergistically to block motor function and has the potential to reduce the amount of local anesthetic needed for spinal block. The synergistic effect of ephedrine in combination with local anesthetics is an interesting pharmacological phenomenon that warrants further clinical evaluation.

A comparative study of low-dose hyperbaric spinal lidocaine 0.5% versus 5% for continuous spinal anesthesia

A comparative study of low-dose hyperbaric spinal lidocaine 0.5% versus 5% for continuous spinal anesthesia

Intrathecal ropivacaine 5 mg/ml for outpatient knee arthroscopy: a comparison with lidocaine 10 mg/ml

The aim of this prospective, randomised, blind study was to compare the evolution of spinal block produced with 50 mg lidocaine 10 mg/ml and 10 mg ropivacaine 5 mg/ml for outpatient knee arthroscopy. Thirty outpatients undergoing knee arthroscopy received 50 mg of lidocaine 10 mg/ml (n=15) or 10 mg of ropivacaine 5 mg/ml (n=15) intrathecally. The evolution of spinal block was recorded until home discharge, while the occurrence of transient neurologic symptoms (TNS) was evaluated through phone-call follow-ups. The median onset time was 15 (10-21) min with lidocaine and 24 (11-37) min with ropivacaine (P=0.109). Spinal lidocaine resulted in a faster resolution of sensory block [148 (130-167) min vs. 188 (146-231) (P=0.022)], unassisted ambulation with crutches [176 (144-208) min vs. 240 (179-302) min (P=0.014)], and voiding [208 (163-254) min vs. 293 (242-343) min (P=0.001)] than ropivacaine. Recovery of motor function required 113 (95-131) min with lidocaine and 135 (87-183) with ropivacaine (P=0.219). Six lidocaine patients reported TNS (40%) as compared with no patient receiving ropivacaine (0%) (P=0.005). Spinal block produced with 10 mg ropivacaine 5 mg/ml is as effective as that produced by 50 mg of lidocaine 10 mg/ml. Recovery of unassisted ambulation and spontaneous voiding occurred earlier with lidocaine, but this was associated with a markedly higher incidence of TNS.

Factors associated with delayed postsurgical voiding interval in ambulatory spinal anesthesia patients: a prospective cohort study in 3 types of surgery

Background Spinal anesthesia has been considered inappropriate for ambulatory surgery patients because of concern about voiding dysfunction. The purpose of this study was to analyze the relationship between voiding interval and type of surgery under spinal anesthesia with lidocaine and to identify other nonanesthetic risk factors for delayed voiding. Patients and methods A prospective study of 406 patients undergoing to ambulatory surgery under spinal anesthesia with lidocaine was performed. Voiding interval was defined as the time in minutes from the injection of local anesthetic to the patient's first spontaneous voiding. Univariate and multivariate linear regression models were constructed to identify risk factors associated with length of voiding interval. Results A total of 187 patients underwent herniorrhaphy; 187 patients underwent lower limb surgery; and 32 patients went benign anorectal surgery. The mean ± sd voiding interval was 230 ± 50.5 minutes. Factors associated with length of voiding interval in the univariate analysis were sex, body mass index (BMI), type and duration of surgery, lidocaine dose, and volume of fluid administered. Factors that remained significant in the multivariate model were sex, BMI, lidocaine dose and type of surgery: spontaneous voiding came later after inguinal herniorrhaphy surgery than after lower-limb surgery (regression coefficient 20 minutes; 95% confidence interval 11.5–29.8). Multivariate models performed for each type of surgery separately identified sex and lidocaine dose as factors related to length of voiding interval in all types of surgery. Conclusions A longer voiding interval was associated with inguinal herniorrhaphy, spinal lidocaine dose, and male sex.

Low dose of lidocaine: comparison of 15 with 20 mg/ml with dextrose for spinal anesthesia in lithotomy position and ambulatory surgery

Spinal anesthesia with the local anesthetic lidocaine has come under scrutiny because it is associated with transient neurologic symptoms (TNS). Although TNS is not associated with either lidocaine concentration or dose, its incidence has never been examined with very small doses of hyperbaric spinal lidocaine in patients in the lithotomy position. We designed this study prospectively to compare the efficacy of low-dose 15 mg/ml with low-dose 20 mg/ml hyperbaric lidocaine in patients undergoing elective outpatient surgery in the lithotomy position. A total of 100 patients were randomized to receive either 30 mg of 15 mg/ml or the same dose of 20 mg/ml hyperbaric lidocaine. Lidocaine density at 37 degrees C is 1.0241 g/ml for the 15 mg/ml and 1.0260 g/ml for the 20 mg/ml solution. Patients were examined for motor block, sensory block, and block duration. Patients were contacted at 24, 48 and 72 h and questioned about their perceptions of pain after the spinal anesthesia with specific questions designed to diagnose TNS. The spread of analgesia was the same with both solutions of lidocaine. Motor block was incomplete in all patients in both groups. TNS were not observed when low doses of both solutions of lidocaine with dextrose were used in these ambulatory patients in the lithotomy position. Hyperbaric lidocaine results in rapid recovery from sensory block and motor blockade. It may have advantages for patients in a day-case setting. No patients complained of TNS after discharge.

The Use of Lidocaine for Spinal Anesthesia

The Use of Lidocaine for Spinal Anesthesia

The Use of Lidocaine for Spinal Anesthesia

The Use of Lidocaine for Spinal Anesthesia

Commentary on: Lidocaine for spinal anesthesia. A study of the concentration in the spinal fluid

Commentary on: Lidocaine for spinal anesthesia. A study of the concentration in the spinal fluid

Lidocaine for spinal anesthesia. A study of the concentration in the spinal fluid

Lidocaine for spinal anesthesia. A study of the concentration in the spinal fluid

Articaine and lidocaine for spinal anaesthesia in day case surgery

Articaine and lidocaine for spinal anaesthesia in day case surgery

165: Articaine and lidocaine for spinal anaesthesia in day case surgery

165: Articaine and lidocaine for spinal anaesthesia in day case surgery

The Additional Effect of Magnesium Sulfate to Lidocaine in Spinal Anesthesia for Cesarean Section

The Additional Effect of Magnesium Sulfate to Lidocaine in Spinal Anesthesia for Cesarean Section

A comparison of spinal anesthesia with small-dose lidocaine and general anesthesia with fentanyl and propofol for ambulatory prostate biopsy procedures in elderly patients

Study Objective To compare operating conditions, intraoperative adverse events, recovery profiles, postoperative adverse effects, patient satisfaction, and costs of small-dose lidocaine spinal anesthesia with those of general anesthesia using fentanyl and propofol for elderly outpatient prostate biopsy. Design Prospective, randomized, blind study. Setting Outpatient anesthesia unit at a municipal hospital. Patients 80 ASA physical status I and II patients, aged 65 to 80 years, scheduled for outpatient prostate biopsy. Interventions Patients were assigned to receive either spinal anesthesia with 10 mg of hyperbaric 1% lidocaine (L group, n = 40) or anesthetic induction with fentanyl 1 μg · kg −1 IV and 1.0 mg · kg −1 propofol injected at 90 mg · kg −1 · h −1, followed by continuous infusion at 6 mg · kg −1 · h −1 (F/P group, n = 40). Measurements and Main Results Both anesthetic techniques provided acceptable operating conditions for the surgeon. However, a significantly higher frequency of intraoperative hypotension was found in the F/P group than in the L group ( P < 0.05). Time to home readiness was shorter in the F/P group ( P < 0.05). Both techniques had no major postoperative adverse effects and resulted in a high rate of patient satisfaction. Total costs were significantly lower in the L group than in the F/P group ( P < 0.01). Conclusions Spinal anesthesia with 10 mg of hyperbaric 1% lidocaine may be a more suitable alternative to general anesthesia with fentanyl and propofol for ambulatory elderly prostate biopsy in terms of safety and costs.

Spinal 2-Chloroprocaine: A Comparison with Small-Dose Bupivacaine in Volunteers

Ambulatory surgery continues to increase nationwide. Because spinal lidocaine is associated with transient neurologic symptoms, many clinicians have switched to small-dose bupivacaine for outpatient spinal anesthesia. However, bupivacaine often produces inadequate surgical anesthesia and has an unpredictable duration. Preservative-free 2-chloroprocaine (2-CP) has reemerged as an alternative for outpatient spinal anesthesia. We designed this double-blind, randomized, crossover, volunteer study to compare 40 mg of 2-CP with small-dose (7.5 mg) bupivacaine with measures of pinprick anesthesia, motor strength, tolerance to tourniquet and electrical stimulation, and simulated discharge criteria. Peak block height (2-CP average T7 [range T3-10]; bupivacaine average T9 [range T4-L1]), regression to L1 (2-CP 64 +/- 10 versus bupivacaine 87 +/- 41 min), and tourniquet tolerance (2-CP 52 +/- 11 versus bupivacaine 60 +/- 27 min) did not differ between drugs (P = 0.15, 0.12, and 0.40, respectively). However, time to simulated discharge (including time to complete block regression, ambulation, and spontaneous voiding) was significantly longer with bupivacaine (2-CP 113 +/- 14, bupivacaine 191 +/- 30 min, P = 0.0009). No subjects reported transient neurologic symptoms or other side effects. We conclude that spinal 2-CP provides adequate duration and density of block for ambulatory surgical procedures, and has significantly faster resolution of block and return to ambulation compared with 7.5 mg of bupivacaine.