Comparison between two different selective spinal anesthesia techniques in ambulatory knee arthroscopy as fast-track anesthesia

Abstract

Background:There were several studies using either low dose Bupivacaine as unilateral selective spinal anesthesia (SSA) or low dose lidocaine SSA for ambulatory knee arthroscopy. There were many concerns about high failure rate, complications, and different times to home readiness discharges.Aim of the Study:The study aimed to: (1) Compare the clinical efficacy and side effects of two different techniques of SSA in subarachnoid block for ambulatory knee arthroscopy (2) evaluate the possibility of a shorter stay in post-anesthesia care unit (PACU) or eligibility for fast tracking anesthesia (bypassing PACU) after SSA and numbers of patient bypassed PACU (3) compare the time to ambulate and time to home readiness.Patients and Methods:Prospective, randomized and open study was conducted, including 50 outpatients undergoing knee arthroscopy. Patients allocated into two groups: Bupivacaine group (group B); was injected with 3 mg bupivacaine and 10 ug fentanyl intrathecally in lateral decubitus position and remained for 20 min then supine position. Lidocaine group (group L) was injected with 20 mg lidocaine, plus 25 ug fentanyl intrathecally and immediately keeps in the supine position after injection. The quality and durations of motor and sensory block were compared between groups. Sensory block assessed by pin brick method and motor block assessed by Bromage scale. Time spent in PACU, the time to ambulate, and times to home-readiness were compared. Number of patients bypassed PACU was recorded. Side effects as pain, nausea, vomiting, postdural puncture headache, transient neurological symptoms, retention of urine and pruritus were evaluated and compared after SSA.Results:Bupivacaine group provided unilateral spinal anesthesia with significantly longer duration of both motor and sensory blocks than bilateral spinal of lidocaine group P < 0.001 and P < 0.01 respectively. The upper dermatomal height of sensory block reached was T9 and T8 in groups B and L respectively. Group B showed more intense motor block than group L. There was no significant difference between both groups as regards postoperative side effects P > 0.05. Group L patients did not stay in PACU, and all patients bypassed it P < 0.001. Bupivacaine group patients showed significantly longer time to ambulate and time to home-readiness than lidocaine group P < 0.001 and P < 0.01 respectively.Conclusion:Both techniques of SSA were clinically efficient as subarachnoid block, and they had less postoperative side effects. Lidocaine spinal was more eligible for fast-tracking anesthesia than bupivacaine spinal with shorter time to ambulate and home-readiness time.

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

“…The full-text of 123 articles were evaluated, and then, 84 articles were excluded due to the following reasons: no results about the incidence of TNS (n = 42); no other local anesthetics were used (n = 18); conference posters (n = 7); abstracts only (n = 4); protocols (n = 4); healthy subjects (n = 4); non-randomized studies of intervention (n = 2); different anesthetic techniques between groups (n = 1); mixed spinal anesthetics (n = 1); and a brief report (n = 1). Therefore, a total of 39 RCTs were included in the final analysis ( Figure 1) [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18].…”

“…More subsequent studies evaluating the effect of lidocaine on the risk of TNS have been published [2,3]. Furthermore, 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]. Therefore, it is still controversial on the safety of lidocaine for spinal anesthesia during ambulatory surgery in terms of TNS.…”

Evaluation of Postoperative Headache, Back Pain and Urinary Retention in Benign Anorectal Surgical Patients Under Spinal Anesthesia

“…Bu komplikasyonlardan karşımıza en çok çıkanlardan olan postoperatif baş ağrısı, idrar retansiyonu, bel ağrısı; cerrahi pratiğinde bizleri en çok zorlayan sonuçlardandır. 7,8,9 Postdural ponksiyon baş ağrısı (PDPB) duradaki herhangi bir yaralanma sonucu ortaya çıkar. Tipik olarak bilateral, frontal veya retroorbital, oksipital ve enseye doğru uzanan tarzdadır.…”

“…Başlaması genellikle 12-72 saat sonradır, ancak daha erken de ortaya çıkabilir. 7,8,9,10,11,12,13,14 Dural defektten kaçış sonucu oluştuğuna inanılır. Kan damarları üzerinde yüksek çekilme ağrıya katkıda bulunur.…”

“…Oluşma olasılığını arttıran diğer faktörler ise genç yaş, dişi cinsiyet ve gebeliktir. 7,8,9,10,11,12,13,14 Bu nedenle yüksek insidans epidural iğne ile duranın yanlışlıkla delindiği obstetrik hastalarda beklenmelidir (%20-50). Sezaryen nedeniyle spinal anestezi yapılanlarda %3-4 oranında izlenmektedir.…”