ABSTRACT
Neuraxial anesthesia for outpatient surgery can provide excellent anesthesia for certain patients. The short-acting local anesthetic 2-chloroprocaine has an appropriate length of action for short outpatient procedures with a very low risk of transient neurologic symptoms. Epidural anesthesia with short-acting agents can provide good outpatient anesthesia for procedures lasting 90 minutes or longer.
Subject(s)
Ambulatory Surgical Procedures/methods , Anesthesia, Spinal/methods , Anesthesia, Epidural/methods , Anesthetics, Local , Humans , OutpatientsABSTRACT
The major principles of management of bladder function during outpatient neuraxial blockade include choice of short-acting local anesthetics, avoidance of adding epinephrine, and reasonable fluid administration (750 to 1000 mL) to avoid overdistention of the bladder. Data suggest that low-risk patients are at no greater risk of retention than after general anesthesia, and may be discharged home with similar instructions regarding return if unable to void. High-risk patients may require closer monitoring with a BUS, and catheter drainage if volumes exceed 600 mL.
Subject(s)
Anesthesia, Spinal/adverse effects , Anesthetics, Local/adverse effects , Urinary Retention/etiology , Ambulatory Surgical Procedures/adverse effects , Ambulatory Surgical Procedures/methods , Anesthesia, Spinal/methods , Anesthetics, Local/administration & dosage , Bupivacaine/administration & dosage , Bupivacaine/adverse effects , Humans , Lidocaine/administration & dosage , Lidocaine/adverse effects , Nerve Block/adverse effects , Nerve Block/methods , Procaine/administration & dosage , Procaine/adverse effects , Procaine/analogs & derivatives , Urinary Retention/prevention & controlABSTRACT
IMPLICATIONS: The occurrence of transient neurologic symptoms after hypobaric lidocaine spinal anesthesia has not been reported, and may suggest sciatic stretch with neural ischemia rather than maldistribution as the cause of this syndrome.
Subject(s)
Anesthesia, Spinal/adverse effects , Anesthetics, Local/adverse effects , Intraoperative Complications/chemically induced , Lidocaine/adverse effects , Neurotoxicity Syndromes/physiopathology , Prone Position/physiology , Humans , Intraoperative Complications/physiopathology , Male , Middle Aged , Pilonidal Sinus/surgeryABSTRACT
UNLABELLED: Levobupivacaine is the isolated S-enantiomer of bupivacaine and may be a favorable alternative to spinal bupivacaine. However, its clinical efficacy relative to bupivacaine and its dose-response characteristics, in spinal anesthesia, must first be known. This double-blinded, randomized, cross-over study was designed to compare the clinical efficacy of hyperbaric levobupivacaine and bupivacaine for spinal anesthesia. Eighteen healthy volunteers were randomized into three equal groups to receive two spinal anesthetics, one with bupivacaine and the other with levobupivacaine, of equal-milligram doses (4, 8, or 12 mg). We assessed blockade quality and duration with pinprick, transcutaneous electrical stimulation, thigh tourniquet, abdominal and quadriceps muscle strength, modified Bromage scale, and time until achievement of discharge criteria. Sensory and motor block were similar between the same doses of levobupivacaine and bupivacaine (P > 0.56 to 0.86). For example, in the 12-mg groups of levobupivacaine versus bupivacaine, mean duration of tolerance to transcutaneous electrical stimulation at T12 was 100 min for both. The duration of motor block at the quadriceps was 71 versus 73 min, and time until achievement of discharge criteria was 164 min for both. Hyperbaric spinal levobupivacaine has equivalent clinical efficacy to racemic bupivacaine for spinal anesthesia in doses from 4 to 12 mg. IMPLICATIONS: Hyperbaric spinal levobupivacaine has equivalent clinical efficacy to hyperbaric spinal bupivacaine over the 4-12-mg ranges.
