A prospective multicenter trial to determine the incidence of transient neurologic symptoms after spinal anesthesia with phenylephrine added to 0.5% tetracaine.
The addition of vasoconstrictors for spinal anesthesia is controversial, since an increase in the incidence of transient neurologic symptoms (TNS) has been reported. A multicenter, randomized, double-blind study was conducted to assess the effectiveness of spinal anesthesia with phenylephrine in addition to tetracaine as well as the incidence of neurological complications. We studied 64 patients with comparable demographic characteristics who were scheduled for elective surgery for a lower limb, or a gynecological or urological procedure. The patients were allocated randomly into 2 groups. Group P (n = 34) received 0.5% tetracaine in 10% glucose with 0.025% phenylephrine, while group C (n = 30) received 0.5% tetracaine in 10% glucose. Our results showed that only 2 patients (6.7%) in group C experienced TNS, and their symptoms disappeared within 72 hr after anesthesia, while none of the patients (0%) in group P complained of symptoms. The incidence of TNS was thus not significantly different between the two groups. Six hours after the sensory block, group P patients demonstrated sensory disturbance, with the median spinal dermatome corresponding to the L1 segment. Moreover, systolic blood pressure in group P was significantly higher than that in group C, 5 min, 15 min, and 20 min after injection. The incidence of TNS in the present study does not seem to be greater after surgery with spinal anesthesia using 0.5% hyperbaric tetracaine and 0.5 mg phenylephrine than without phenylephrine. Randomized, double-blind, cross-over trials with a larger sample size would be required in the future to obtain more reliable results.
Maehara
Y
Y
Department of Anesthesiology and Critical Care, Faculty of Medicine, Hiroshima University, Japan.
Kusunoki
S
S
Kawamoto
M
M
Yuge
O
O
Okida
M
M
Kinoshita
H
H
Nakagawa
I
I
Nakao
M
M
Sasaki
H
H
D000775:Anesthesia, Spinal / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology; D010146:Pain; D010656:Phenylephrine / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D013748:Tetracaine / Q000009:adverse effects*; D013520:Urologic Surgical Procedures; D014662:Vasoconstrictor Agents / Q000009:adverse effects*
D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D013748:Tetracaine; D010656:Phenylephrine