Use of spinal anaesthesia in day surgery.
OBJECTIVE
An increasing number of day-case surgical patients is challenging the presently used methods of anaesthesia: reliable surgical anaesthesia should be fast, with rapid recovery and minimal side effects. To compete with modern ambulatory general anaesthesia a knowledge of special spinal anaesthesia techniques is essential. This review brings together important issues concerning the spinal technique, anaesthetic agents and benefits as well as the disadvantages of spinal anaesthesia in outpatients.


RESULTS
For surgical procedures in one lower limb, a low dose of hyperbaric bupivacaine with standardized spinal anaesthesia technique produces a reliable block, with low incidence of side effects and home-readiness equal to spinal anaesthesia with lidocaine (50 mg) or general anaesthesia (desflurane), whereas ropivacaine has not shown benefits over spinal anaesthesia with bupivacaine. 'Walk-in, walk-out' spinals with an extremely low dose of lidocaine and opioids for gynaecological laparoscopy created the concept of selective spinal anaesthesia. Reintroduction of chloroprocaine may provide a solution for bilateral, short-acting spinal anaesthesia in the future.


CONCLUSIONS
To produce reliable spinal anaesthesia with a reasonable recovery time it is essential to understand the factors affecting the spread of spinal block and to choose the optimal drug and adequate dose for specific surgical procedures.
Korhonen
Anna-Maija
AM
Department of Intensive Care Medicine, Meilahti University Hospital, Finland. Anna-maija.korhonen@hus.fi
D000556:Ambulatory Surgical Procedures; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000762:Anesthesia Recovery Period; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D013505:Digestive System Surgical Procedures; D013509:Gynecologic Surgical Procedures; D059685:Herniorrhaphy; D006801:Humans; D007278:Injections, Spinal; D010535:Laparoscopy; D035002:Lower Extremity / Q000601:surgery; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control; D051299:Post-Dural Puncture Headache / Q000209:etiology; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced; D017410:Practice Guidelines as Topic; D011343:Procaine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D013520:Urologic Surgical Procedures
D000700:Analgesics; D000779:Anesthetics, Local; D011343:Procaine; C004616:chloroprocaine