title: Subarachnoid small-dose bupivacaine versus lidocaine for cervical cerclage.
abstract: Cervical cerclage is often performed as an outpatient procedure under subarachnoid anesthesia. Lidocaine was historically the drug of choice for short procedures but has fallen out of favor because of concerns of transient neurologic symptoms (TNS). We performed this study to determine whether small-dose bupivacaine is an acceptable alternative to lidocaine for cervical cerclage. We randomized 59 women to receive either subarachnoid isobaric lidocaine 30 mg or hyperbaric bupivacaine 5.25 mg. Fentanyl 20 micro g was added to both local anesthetics, and the total volume was diluted to 3 mL with 0.9% saline. Onset and highest dermatomal level of sensory block; quality of anesthesia; hypotension; and times until T12 regression, return of lower extremity motor function, ambulation, and micturition were recorded. Symptoms of TNS were evaluated by telephone interview 24 h after surgery. We did not find any significant difference in onset or recovery times between the groups, with the exception of a longer duration until return of lower extremity motor strength in the lidocaine group. Symptoms consistent with TNS that resolved spontaneously within 48 h were reported by two women in the lidocaine group but by none in the bupivacaine group. We conclude that subarachnoid bupivacaine offers a satisfactory alternative to subarachnoid lidocaine for cervical cerclage.
  
  
  CONCLUSIONS
  We found that small-dose subarachnoid bupivacaine (5.25 mg) with fentanyl 20 micro g provides reliable anesthesia for cervical cerclage and exhibits a pharmacodynamic profile similar to that of small-dose lidocaine.
authors.affiliation: Department of Anesthesiology, Mount Sinai School of Medicine, New York University, New York 10029, USA. Yaakov.Beilin@mountsinai.org
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Beilin
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Zahn
authors.forename: Sharon
authors.initials: S
authors.lastname: Abramovitz
authors.forename: Howard H
authors.initials: HH
authors.lastname: Bernstein
authors.forename: Sabera
authors.initials: S
authors.lastname: Hossain
authors.forename: Carol
authors.initials: C
authors.lastname: Bodian
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural; D000775:Anesthesia, Spinal; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D023802:Cerclage, Cervical; D005260:Female; D005283:Fentanyl; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects; D009407:Nerve Block; D020258:Neurotoxicity Syndromes / Q000453:epidemiology; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011247:Pregnancy; D013346:Subarachnoid Space
chemical_list: D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D008012:Lidocaine; D005283:Fentanyl; D002045:Bupivacaine