Abstract ID: A11

Abstract Title: Lidocaine versus Mepivacaine: A Comparison of Anesthetic and Recovery and Profiles, including Incidence of Transient Neurological Symptoms after Spinal Anesthesia for Patients Undergoing Ambulatory Anterior Cruciate Ligament Repair

Authors: Melton, M.D. M¹, Pappas, M.D. A², Fluder, R.N. E³, Pawlowski, M.D. J⁴
Loyola University Medical Center Maywood IL ¹, Loyola University Medical Maywood IL ², Loyola University Medical Center Maywood IL ³, Loyola University Medical Center Maywood IL ⁴
Poster Type: Either

ABSTRACT BODY

Introduction: The low risk of postdural puncture headache with the use of small gauge pencil point needles has promoted the use of spinal anesthesia in ambulatory surgery. Reports of transient neurological symptoms (TNS) with intrathecal lidocaine have generated interest in alternative local anesthetics for ambulatory spinal anesthesia.1 This study compared anesthesia and recovery profiles of equal doses and concentrations of mepivacaine versus lidocaine in patients undergoing spinal anesthesia for ambulatory anterior cruciate ligament (ACL) repair.
Materials and Methods: 78 outpatients, ASA class I and II, undergoing ACL repair were enrolled in this prospective, randomized, double blind study. Patients were randomly divided into one of two treatment groups: Group I, received 4 ml of 2% plain spinal lidocaine and Group II, 4 ml of 2% plain spinal mepivacaine. A combined spinal epidural technique at L2-3 or L3-4 was done using an 18g Tuohy and 27g Pencan needle. After injection of the appropriate study drug, the spinal needle was removed and a 20 gauge epidural catheter was inserted 4-5 cm into the epidural space. Supplementation of anesthesia through the epidural catheter was initiated only if the patient reported discomfort at the surgical site, with 5 ml increments of 3% chloroprocaine with 1:200K epinephrine to a total of 15ml. Sensory and motor block was assessed at 5-minute intervals for 20 minutes and subsequently every 20 minutes until complete recovery with follow-up phone calls postoperative days one, two and three.
Results: There was no demographic difference between groups. Intraoperative data revealed no significant difference in episodes of hypotension, bradycardia or nausea and vomiting. Motor and sensory block recovery of 2-segment regression were statistically similar. Recovery profiles including time to void, time to ambulation and PACU stay times were statistically similar. The 24, 48 and 72 hour recoveries were similar in regards to fatigue, nausea and backache. The incidence of TNS for lidocaine and mepivacaine was 15% (6/41) and 8% (3/37) respectively.
Discussion: The relative risk of developing TNS is approximately seven times more for intrathecal lidocaine than bupivacaine, prilocaine and procaine, however, longer duration or insufficient quality of anesthesia may limit their suitability for ambulatory surgery.1 Mepivacaine is a potential alternative to lidocaine for ambulatory spinal anesthesia. 2 Reports of TNS with mepivacaine are from 0 to 30%.1 More studies are needed to evaluate the frequency of TNS with mepivacaine after it use for spinal anesthesia.1 Our study of equal doses and concentrations of lidocaine versus mepivacaine for spinal anesthesia in patients undergoing ambulatory ACL repair found statistically similar anesthetic and recovery profiles with a lower incidence of TNS with mepivacaine.
References: 1. Zaric D, Christiansen C, Pace N, Punjasawadwong Y. Transient neurological symptoms after spinal anesthesia with lidocaine versus other local anesthetics: A systematic review of randomized, controlled trials. Anesth Analg 2005;100:1811-6.
2. Ligouri GA, Zayes M, Chisholm MF: Transient neurologic symptoms after spinal anesthesia with mepivacaine and lidocaine. Anesthesiology 1998;88:619-23.

ATTACHED FILES

A11_Elicitation of TNS.doc

A11_Demographic and Recovery Parameters.doc

A11_Discharge Milestones and Incidence of TNS.doc

Reg Anesth Pain Med 2005; 30(3):A11