Small-dose intrathecal lidocaine versus ropivacaine for anorectal surgery in an ambulatory setting.
Spinal anesthesia with the local anesthetic lidocaine has come under scrutiny because it is associated with transient neurologic symptoms (TNS). We designed this study to prospectively compare the efficacy of ropivacaine as an alternative to lidocaine in patients undergoing elective outpatient anorectal procedures. Seventy-two patients were randomized to receive either hyperbaric lidocaine 25 mg with fentanyl 20 microg (n = 37) or hyperbaric ropivacaine 4 mg with fentanyl 20 microg (n = 35). Patients were examined for motor block, sensory block, and block duration. Patients were contacted at 24, 48, 72, and 168 h and questioned about their perceptions of pain after the spinal with specific questions designed to diagnose TNS. There were no patients with TNS in either group. There was no significant difference between the lidocaine and ropivacaine groups in any of the outcomes studied. In conclusion, intrathecal hyperbaric small-dose ropivacaine with fentanyl is an acceptable anesthetic for anorectal surgery.


CONCLUSIONS
In this prospective trial, small-dose ropivacaine with fentanyl was as effective as small-dose lidocaine with fentanyl for anorectal procedures in the ambulatory setting.
Buckenmaier
Chester C
CC
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA. bucke001@mc.duke.edu
Nielsen
Karen C
KC
Pietrobon
Ricardo
R
Klein
Stephen M
SM
Martin
Aliki H
AH
Greengrass
Roy A
RA
Steele
Susan M
SM
D000759:Adjuvants, Anesthesia; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000577:Amides / Q000008:administration & dosage; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000008:administration & dosage; D013505:Digestive System Surgical Procedures; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl; D006801:Humans; D007278:Injections, Spinal; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D000077212:Ropivacaine; D011795:Surveys and Questionnaires
D000759:Adjuvants, Anesthesia; D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D008012:Lidocaine; D005283:Fentanyl