Transient neurologic symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics

Spinal hyperbaric prilocaine vs. mepivacaine in perianal outpatient surgery

“…The cause of this painful complication is as yet unknown and none of the speculations on its origin have been substantiated [3]. Previous studies indicated TNS to be a substance-specific effect, neither concentration nor dose dependent [7,8].…”

“…We performed a power analysis according to the Cochrane review of Zaric and Pace [3] assuming 0.2 % for prilocaine and 10 % for mepivacaine as TNS proportions. With alpha = 0.05 and power = 0.80 we assessed a total sample size of 156.…”

“…These symptoms appear as pain or abnormal sensations in the gluteal region and the lower extremities within 24h after an uneventful SPA, last for 1-3 days and disappear without sequelae [3][4][5]. Hyperbaric mepivacaine was initially a promising alternative.…”

“…Hyperbaric mepivacaine was initially a promising alternative. But shortly thereafter, the incidences for TNS for mepivacaine and lidocaine were shown to be nearly similar [3,6]. However, until the introduction of hyperbaric prilocaine 20 mg/ml into the German market in the year 2010, there has been no alternative approved hyperbaric local anaesthetic with a comparable pharmacokinetic profile.…”

Discharge times for knee arthroscopy in spinal vs. general anesthesia

“…So many authors tried to optimize the dosage and concentration of bupivacaine for ambulatory knee surgery, but achieved only a recovery profile comparable to GA [8][9][10]. In 2010, after introduction of hyperbaric prilocaine 2% to the German market, a medium-long acting local anesthetic with pharmacological characteristics comparable to lidocaine and mepivacaine but a remarkable lower incidence of TNS, a nearly perfect substance for this indication seemed to be available [11]. We assumed that due to a shorter duration of action of prilocaine compared to bupivacaine, a SPA could lead to a faster recovery than a GA.…”