Low dose lignocaine + butorphanol vs. low dose bupivacaine for spinal anaesthesia in day care urological surgeries: a prospective randomized control trial

Abstract

Objective: A local anaesthetic with fast onset, short and reliable duration of anaesthesia may be preferable for day care urological surgeries. Low dose lignocaine is believed to act faster and to have a shorter duration of action than low dose bupivacaine. Use of lignocaine for spinal anesthesia is discouraged now a days because of rare reports of transient neurological symptoms. The purpose of this study was to compare effectiveness and safety of low dose of lignocaine + butorphanol against low dose of bupivacaine for day care urological surgeries. Material and methods:A prospective randomized control trial was conducted between December 2012 to November 2015. After taking ethical committe approval and patient consent, total 990 patients were randomized in two groups. Group A received 0.5 mL of 5% lignocaine (25 mg) + 0.3 mL butorphanol (0.3 mg) and group B received 1 mL of 0.5% bupivacaine (5 mg) for spinal anesthesia. Spinal anesthesia was given at the L3-L4 interspace with the patient in the sitting or lateral position. The criteria for evaluation were time till onset of sensory and motor block, duration of sensory and motor block, time till ambulation, time till fit for discharge and any complications. Results:Both the groups were comparable in terms of age, male to female ratio, American Society of Anesthesiologists (ASA) grade and duration surgery. Group A and Group B were statistically different in terms of mean time till onset of sensory block (120±22 sec and 274±36 sec), onset of motor block (228±34 sec and 372±41 sec), duration of sensory block (100±21 min and 230±28 min), duration of motor block (60±15 min and 152±23 min), time till ambulation (138±24 min and 292±48 min), time till fit for discharge (256±35 min and 428±46 min) respectively (<0.0001). Nausea, vomitings, hypotension, bradycarida and pruritis were less in group A compared to group B (<0.01). None of patient in any group had temporary or permanent neurological defecit. Conclusion:Spinal anaesthesia is an effective as well as a safe modality to anaesthetize the patient for day care urological procedures. This study shows lignocaine + butorphanol is preferable over bupivacaine for spinal anesthesia for day care urological procedures. It also favours day care surgery at remote areas with lesser medical facilities. It helps to minimize requirement of medical and paramedical staff, thus further extending scope of day care urological surgeries.

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

“…However, the risk ratio and prevalence of developing TNS of the current study was slightly lower than those of the previous studies; Zaric [3]. These difference can be explained in part by that many RCTs of the present meta-analysis reported no case of TNS in the lidocaine group [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18], and a continuity correction of 0.5 was applied to these zero total events trials to prevent the overestimation of the risk of TNS [21]. Among other local anesthetics, chloroprocaine and mepivacaine have similar characteristics with lidocaine in terms of rapid onset time and short duration [47,48].…”

“…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].…”

“…All these RCTs compared lidocaine with other local anesthetics (bupivacaine, prilocaine, mepivacaine, levobupivacaine, chloroprocaine, ropivacaine, procaine, articaine, or sameridine) and reported the incidence of TNS. We found that 28 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]. Five out of 11 RCTs have more than two lidocaine groups [16,24,28,33,43].…”

“…One study had two treatment groups that administered hyperbaric or isobaric lidocaine [43]. Since 6 studies failed to report the baricity of lidocaine [10,12,37,38,40,46], those RCTs were excluded from subgroup analysis. The risk of TNS was higher in the lidocaine group compared with the control group when hyperbaric (RR = 3.59, 95% CI = 2.03 to 6.33, p < 0.001) or isobaric lidocaine (RR = 4.45, 95% CI = 2.86 to 6.93, p < 0.001) was used.…”

“…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.…”