Selective spinal anesthesia for outpatient laparoscopy. II: epinephrine and spinal cord function.
OBJECTIVE
To compare two small-dose solutions (with and without epinephrine) for spinal anesthesia during outpatient laparoscopy and to determine spinal cord function with these low-dose solutions.


METHODS
Twenty outpatients undergoing gynecological laparoscopy were randomly assigned to receive spinal anesthesia with one of two low dose solutions. Group LS-10 mg lidocaine plus 10 microg sufentanil; Group LSE-10 mg lidocaine plus 10 microg sufentanil plus epinephrine 50 microg. Solutions were diluted to three millilitres with sterile water for injection. A 27-gauge Whitacre needle was inserted at L2-3 or L3-4 in the sitting position. Operating conditions and spinal cord function (spinothalamic, dorsal column and motor) were assessed.


RESULTS
Operating conditions were good-excellent in both groups. The incidence of shoulder tip discomfort, pruritus and nausea, and the amount of supplementation with alfentanil and midazolam was not different between groups. Most patients in both groups had preserved dorsal column function and normal motor power on arrival in PACU and were able to satisfy 'walk out' criteria. Recovery of pinprick sensation and discharge times were not different. Mild pruritus (VAS score < or = 5) was present in both groups.


CONCLUSIONS
For short duration laparoscopy, addition of 50 microg epinephrine to a small dose of spinal 10 mg lidocaine with 10 microg sufentanil did not provide additional benefit in terms of intraoperative analgesia or operating conditions. Spinal cord function was preserved with small-dose techniques.
Vaghadia
H
H
Department of Anesthesia, Vancouver General Hospital, University of British Columbia, Canada. hvaghadi@vanhosp.bc.ca
Solylo
M A
MA
Henderson
C L
CL
Mitchell
G W
GW
D000328:Adult; D000556:Ambulatory Surgical Procedures; D000775:Anesthesia, Spinal / Q000009:adverse effects; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008012:Lidocaine; D013116:Spinal Cord / Q000187:drug effects*; D017409:Sufentanil; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D017409:Sufentanil; D004837:Epinephrine