Transient Neurologic Symptoms After Spinal Anesthesia with Lidocaine Versus Other Local Anesthetics: A Systematic Review of Randomized, Controlled Trials

Abstract

Lidocaine has been used for spinal anesthesia since 1948, seemingly without causing concern. However, during the last 10 years, a number of reports have appeared implicating lidocaine as a possible cause of neurologic complications after spinal anesthesia. Follow-up of patients who received uncomplicated spinal anesthesia revealed that some of them developed pain in the lower extremities--transient neurologic symptoms (TNS). In this study, we sought to compare the frequency of 1) TNS and 2) neurologic complications after spinal anesthesia with lidocaine with that after other local anesthetics. Published trials were identified by computerized searches of The Cochrane Library, MEDLINE, LILAC, and EMBASE and by checking the reference lists of trials and review articles. The search identified 14 trials reporting 1347 patients, 117 of whom developed TNS. None of these patients showed signs of neurologic complications. The relative risk for developing TNS after spinal anesthesia with lidocaine was higher than with other local anesthetics (bupivacaine, prilocaine, procaine, and mepivacaine), i.e., 4.35 (95% confidence interval, 1.98-9.54). There was no evidence that this painful condition was associated with any neurologic pathology; in all patients, the symptoms disappeared spontaneously by the 10th postoperative day.

Mépivacaïne rachidienne additionnée de fentanyl pour une arthroscopie du genou en ambulatoire: une étude randomisée contrôlée

“…13 Lidocaine, traditionally the most widely used local anesthetic agent for ambulatory surgical procedures because of its short duration of action, has been implicated in cases of both temporary and permanent neurological deficits. Recent interest in finding alternatives to lidocaine has been fuelled by an unacceptably high rate of TNS (reportedly up to 32%), 8 leading to studies with procaine, 14 prilocaine, 15 and dilute bupivacaine, 16 with or without fentanyl. 17 While bupivacaine is associated with a lower incidence of TNS (0-3%), the prolonged duration of motor blockade and increased risk of urinary retention make bupivacaine less than ideal for outpatient surgery.…”

“…5,6 Lidocaine has a favourable pharmacokinetic profile for ambulatory surgery, but its use is limited by an unacceptably high incidence of transient neurological symptoms (TNS). [7][8][9] Mepivacaine is physicochemically similar to lidocaine and widely used for brachial plexus anesthesia, but its application in spinal anesthesia has been relatively limited to date. In a previous dose-response study, Zayas et al demonstrated that a reduction in the intrathecal dose of mepivacaine 1.5% from 45 to 30 mg significantly reduced the duration of motor blockade by nearly 20%, but almost one-third of patients who received 30 mg experienced intraoperative pain or discomfort.…”

Comparison of bupivacaine and 2-chloroprocaine for spinal anesthesia for outpatient surgery: a double-blind randomized trial

“…However, transient neurological symptoms (TNS), described as back pain with irradiation to the lower extremities, have been reported. [3][4][5][6][7] This information has prompted many practitioners to abandon the use of lidocaine for spinal anesthesia.…”

Study -“Comparative Study of Combined Spinal Epidural Versus Epidural Anaesthesia in Lower Limb Surgeries And Lower Abdominal Surgeries ”

“…TNS occurs in about 14% of patients receiving lidocaine spinal anaesthesia. 43 Bupivacaine as a viable alternative to lidocaine for spinal anaesthesia has been used frequently with very little incidence of TNS. 44 Onset of anaesthesia occurs in 8 min with a duration lasting from 210 to 240 min.…”