title: Small-dose hypobaric lidocaine-fentanyl spinal anesthesia for short duration outpatient laparoscopy. I. A randomized comparison with conventional dose hyperbaric lidocaine.
abstract: A randomized, single-blind trial of two spinal anesthetic solutions for outpatient laparoscopy was conducted to compare intraoperative conditions and postoperative recovery. Thirty women (ASA physical status I and II) were assigned to one of two groups. Group I patients received a small-dose hypobaric solution of 1% lidocaine 25 mg made up to 3 mL by the addition of fentanyl 25 micrograms. Group II patients received a conventional-dose hyperbaric solution of 5% lidocaine 75 mg (in 7.5% dextrose) made up to 3 mL by the addition of 1.5 mL 10% dextrose. All patients received 500 mL of crystalloid preloading. Spinal anesthesia was performed at L2-3 or L3-4 with a 27-gauge Quincke point needle. Surgery commenced when the level of sensory anesthesia reached T-6. Intraoperative hypotension requiring treatment with ephedrine occurred in 54% of Group II patients but not in any Group I patients. Median (range) time for full motor recovery was 50 (0-95) min in Group I patients compared to 90 (50-120) min in Group II patients (P = 0.0005). Sensory recovery also occurred faster in Group I patients (100 +/- 22 min) compared with Group II patients (140 +/- 27 min, P = 0.0001). Postoperative headache occurred in 38% of all patients and 70% of these were postural in nature. Oral analgesia was the only treatment required. Spinal anesthesia did not result in a significant incidence of postoperative backache. On follow-up, 96% said they found spinal needle insertion acceptable, 93% found surgery comfortable, and 90% said they would request spinal anesthesia for laparoscopy in future. Overall, this study found spinal anesthesia for outpatient laparoscopy to have high patient acceptance and a comparable complication rate to other studies. The small-dose hypobaric lidocaine-fentanyl technique has advantages over conventional-dose hyperbaric lidocaine of no hypotension and faster recovery.
authors.affiliation: Department of Anaesthesia (Division of Ambulatory Anaesthesia, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Canada. hvaghadi@vanhosp.bc.ca
authors.forename: H
authors.initials: H
authors.lastname: Vaghadia
authors.forename: D H
authors.initials: DH
authors.lastname: McLeod
authors.forename: G W
authors.initials: GW
authors.lastname: Mitchell
authors.forename: P M
authors.initials: PM
authors.lastname: Merrick
authors.forename: C R
authors.initials: CR
authors.lastname: Chilvers
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures; D000762:Anesthesia Recovery Period; D000775:Anesthesia, Spinal / Q000009:adverse effects; D019162:Anesthetics, Combined; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D010535:Laparoscopy; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D016037:Single-Blind Method; D013046:Specific Gravity; D013246:Sterilization, Tubal
chemical_list: D019162:Anesthetics, Combined; D008012:Lidocaine; D005283:Fentanyl