Motor power pharmacodynamics of subarachnoid hyperbaric 5% lidocaine in the sitting position.
BACKGROUND
Repetitive dynamometric measurement using a plantar flexion power device (PFPD) provides detailed data describing the onset and offset of motor block following spinal administration of lidocaine. The aim of this study was to evaluate administration of two doses of spinal lidocaine in the sitting position to determine whether our dynamometric model produces data consistent with our current understanding of the pharmacokinetics of subarachnoid, hyperbaric, 5% lidocaine.


METHODS
Twenty male patients (54 to 80 yr) undergoing cystoscopy received spinal anaesthesia with either 75 mg (n = 10) or 100 mg of hyperbaric lidocaine 5%, in the sitting position, under standardised conditions. Plantar flexion muscle power was recorded during onset and offset of anaesthesia using a load cell interfaced with a computer (PFPD).


RESULTS
Onset of paralysis following spinal block in the sitting position was rapid and complete with motor power declining exponentially to 5% of preoperative values by 8.5 min in all patients. There was no difference in decay or recovery of plantar flexion motor power data between dosage groups in the sitting position. Measurement using the PFPD shows that onset of motor paralysis is described by an exponential decay and that motor recovery occurs at a fixed rate. Extent of block to cold and pinprick was similar in both dosage groups in the sitting position (median T4).


CONCLUSIONS
This study shows that in the sitting position, doses less than 75 mg of 5% hyperbaric lidocaine are required to significantly improve ambulatory times.
Rushmer
J
J
Division of Anaesthesiology & Intensive Care, Royal Brisbane Hospital, University of Queensland, Australia.
Miles
W
W
Jones
R D
RD
Ho
J Y
JY
Cheung
C K
CK
Chan
S S
SS
D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000008:administration & dosage; D003558:Cystoscopy; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007537:Isometric Contraction / Q000187:drug effects; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000187:drug effects*; D010147:Pain Measurement / Q000187:drug effects; D011187:Posture / Q000502:physiology*; D013346:Subarachnoid Space; D004561:Transcutaneous Electric Nerve Stimulation; D016138:Walking
D000779:Anesthetics, Local; D008012:Lidocaine