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Combination of hyperbaric lidocaine and ropivacaine in spinal anaesthesia for day surgery

Published online by Cambridge University Press:  01 March 2006

H. Kallio ,
E.-V. T. Snäll ,
C. A. Tuomas  and
P. H. Rosenberg
H. Kallio
Affiliation:
Helsinki University Central Hospital, Department of Anaesthesiology and Intensive Care Medicine, Helsinki, Finland Forssa Hospital, Department of Anaesthesiology, Forssa, Finland
E.-V. T. Snäll
Affiliation:
Forssa Hospital, Department of Anaesthesiology, Forssa, Finland
C. A. Tuomas
Affiliation:
Forssa Hospital, Department of Anaesthesiology, Forssa, Finland
P. H. Rosenberg
Affiliation:
Helsinki University Central Hospital, Department of Anaesthesiology and Intensive Care Medicine, Helsinki, Finland
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Extract

Summary

Background and objective: Motor function recovers rapidly but the extended duration of sensory block after spinal anaesthesia with hyperbaric ropivacaine may delay patients' ambulation after surgery. We tested whether compensating a reduction of the ropivacaine dose with a small dose of lidocaine would be adequate for surgery and shorten recovery from spinal anaesthesia. Methods: Fifty-six consecutive outpatients, who were scheduled for lower extremity surgery under spinal anaesthesia, were randomized into two groups to receive either a hyperbaric solution of lidocaine 20 mg and ropivacaine 5 mg (Group LR) or hyperbaric ropivacaine 10 mg (Group R). Sensory block was tested with pinprick and motor block on the Bromage scale at 5-min intervals until 30 min, then at 15-min intervals until 90 min, and thereafter at 30-min intervals until full bilateral recovery. Blinded interviews were performed on the first and seventh postoperative day. Results: The groups did not differ significantly regarding success of sensory block reaching T10 dermatome on the operative side, 24 (86%) in Group LR and 23 (82%) in Group R, median (range) onset time 5 (5–20) vs. 10 (5–25) min or median duration of T10 sensory block 68 (5–115) vs. 50 (20–115) min, respectively. Two patients in each group required general anaesthesia. Recovery did not differ between the groups, median time of full motor recovery was 75 min in both groups, sensory recovery of S2 2.5 h vs. 2.8 h, first voluntary micturition 4.2 (2.2–6.1) vs. 4.5 (2.4–6.6) h in the LR vs. R Group, respectively. Transient neurological symptoms did not appear. Conclusion: It is concluded that spinal anaesthesia with hyperbaric lidocaine 20 mg + ropivacaine 5 mg and hyperbaric ropivacaine 10 mg was quite similar regarding frequency, onset, duration of T10 dermatome sensory block and recovery. The patients would have been ready for discharge after voluntary micturition, 4.2–4.5 h from the subarachnoid injection of local anaesthetics.

Keywords

ANAESTHESIA, SPINALSURGERY, AMBULATORYANAESTHETICS LOCAL, ropivacaine, lidocaine
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 7 , July 2006 , pp. 568 - 573
Copyright
© 2006 European Society of Anaesthesiology

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Footnotes

Presented in part as a poster at Annual Meeting of the American Society of Anesthesiologists 2005 October 24th, Atlanta, USA.

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