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Transient neurological symptoms with subarachnoid lidocaine: effect of early mobilization

Published online by Cambridge University Press:  13 April 2005

B. G. Cramer ,
R. Stienstra ,
A. Dahan ,
M. S. Arbous ,
B. Th. Veering  and
J. W. Van Kleef
B. G. Cramer
Affiliation:
Leiden University Medical Center, Department of Anesthesiology, Leiden, The Netherlands
R. Stienstra
Affiliation:
Leiden University Medical Center, Department of Anesthesiology, Leiden, The Netherlands
A. Dahan
Affiliation:
Leiden University Medical Center, Department of Anesthesiology, Leiden, The Netherlands
M. S. Arbous
Affiliation:
Leiden University Medical Center, Department of Anesthesiology, Leiden, The Netherlands
B. Th. Veering
Affiliation:
Leiden University Medical Center, Department of Anesthesiology, Leiden, The Netherlands
J. W. Van Kleef
Affiliation:
Leiden University Medical Center, Department of Anesthesiology, Leiden, The Netherlands
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Extract

Summary

Background and objective: Although lidocaine has been used extensively for spinal anaesthesia since 1949, it has been associated with transient neurological symptoms only in the past 10 yr. It has been suggested that early ambulation after spinal anaesthesia, as opposed to traditional 24 h recumbency, might be the causative factor for the development of transient neurological symptoms. The purpose of this study was to examine the effect of early ambulation on the incidence of transient neurological symptoms after single injection spinal anaesthesia with lidocaine 2%.

Methods: Sixty patients undergoing minor surgery under spinal anaesthesia were included. All patients received lidocaine 60 mg. After the establishment of successful subarachnoid block, patients were randomly allocated to two groups of 30 patients. Patients in Group 1 were ambulated as soon as possible, whereas patients in Group 2 were kept recumbent until 6 h after subarachnoid injection. Two days after surgery patients were contacted by a blinded observer and interviewed of transient neurological symptoms using a standardized questionnaire. Patients were asked to express the intensity of pain/discomfort on a verbal rating scale from 0 (no pain) to 10 (worst pain imaginable).

Results: There was no significant difference in the incidence of transient neurological symptoms (23% vs. 27%). In all patients, symptoms resolved completely within 6–24 h. The median pain score was 5 (range 2–8) in Group 1 and 7 (range 1–8) in Group 2.

Conclusions: Under the conditions of this study, there is no correlation between the time of ambulation after spinal anaesthesia with lidocaine and the incidence of transient neurological symptoms.

Keywords

ANAESTHESIA, CONDUCTION, adverse effectsANAESTHESIA, SPINAL, transient neurological symptoms, early ambulationLIDOCAINE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 1 , January 2005 , pp. 35 - 39
Copyright
© 2005 European Society of Anaesthesiology

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References

Schneider M, Ettlin T, Kaufmann M, et al. Transient neurologic toxicity after hyperbaric subarachnoid anesthesia with 5% lidocaine. Anesth Analg 1993; 76: 1154–1157.Google Scholar
Tarkkila P, Huhtala J, Tuominen M. Transient radicular irritation after spinal anaesthesia with hyperbaric 5% lignocaine. Br J Anaesth 1995; 74: 328–329.Google Scholar
Hampl KF, Schneider MC, Ummenhofer W, et al. Transient neurologic symptoms after spinal anesthesia. Anesth Analg 1995; 81: 1148–1153.Google Scholar
Pollock JE, Neal JM, Stephenson CA, et al. Prospective study of the incidence of transient radicular irritation in patients undergoing spinal anesthesia. Anesthesiology 1996; 84: 1361–1367.Google Scholar
Freedman JM, Li D-K, Drasner K, et al. Transient neurologic symptoms after spinal anesthesia. An epidemiologic study of 1,863 patients. Anesthesiology 1998; 89: 633–641.Google Scholar
Carbaat PA, Van Crevel H. Lumbar puncture headache: controlled study on the preventive effect of 24 hours' bedrest. Lancet 1981; 2: 1133–1135.Google Scholar
Hampl KF, Schneider MC, Pargger H. A similar incidence of transient neurologic symptoms after spinal anesthesia with 2% and 5% lidocaine. Anesth Analg 1996; 83: 1051–1054.Google Scholar
Salmela L, Aromaa U. Transient radicular irritation after spinal anesthesia induced with hyperbaric solutions of cerebrospinal fluid-diluted lidocaine 50 mg/ml or mepivacaine 40 mg/ml or bupivacaine 5 mg/ml. Acta Anaesthesiol Scand 1998; 42: 765–769.Google Scholar
Pollock JE, Liu SS, Neal JM, et al. Dilution of spinal lidocaine does not alter the incidence of transient neurologic symptoms. Anesthesiology 1999; 90: 445–450.Google Scholar
Le Truong HH, Girard MG, Drolet P, et al. Spinal anesthesia: a comparison of procaine and lidocaine. Can J Anesth 2001; 48: 470–473.Google Scholar
Hampl K, Schneider M. Transient radicular irritation after spinal anesthesia with xylocain. Acta Anaesthesiol Scand 1999; 43: 359–360.Google Scholar
Naveira FA, Copeland S, Anderson M, et al. Transient neurologic toxicity after spinal anesthesia, or is it myofascial pain? Two case reports. Anesthesiology 1998; 88: 268–270.Google Scholar
Lambert LA, Lambert DH, Strichartz GR. Irreversible conduction block in isolated nerve by high concentrations of local anesthetics. Anesthesiology 1994; 80: 1082–1093.Google Scholar
Bainton CR, Strichartz GR. Concentration dependence of lidocaine-induced irreversible conduction loss in frog nerve. Anesthesiology 1994; 81: 657–667.Google Scholar
Corbey MP, Bach AB. Transient radicular irritation (TRI) after spinal anaesthesia in day-care surgery. Acta Anaesthesiol Scand 1998; 42: 425–429.Google Scholar
Ostgaard G, Hallaraker O, Ulveseth OK, et al. A randomised study of lidocaine and prilocaine for spinal anaesthesia. Acta Anaesthesiol Scand 2000; 44: 436–440.Google Scholar
Salazar F, Bogdanovich A, Adalia R. Transient neurologic symptoms after spinal anaesthesia using isobaric 2% mepivacaine and isobaric 2% lidocaine. Acta Anaesthesiol Scand 2001; 45: 240–245.Google Scholar
Douglas MJ. Neurotoxicity of lidocaine – does it exist? Can J Anaesth 1995; 42: 181–185.Google Scholar
Dahlgren N. Reply 2. Acta Anaesthesiol Scand 1996; 40: 865.Google Scholar
Dahlgren N. Lidocaine neurotoxicity: a technical knock-out below the waist? Acta Anaesthesiol Scand 1998; 42: 389–390.Google Scholar
Lindh A, Andersson AS, Westman L. Is transient lumbar pain after spinal anaesthesia with lidocaine influenced by early mobilisation? Acta Anaesthesiol Scand 2001; 45: 290–293.Google Scholar