Transient neurological symptoms after isobaric subarachnoid anesthesia with 2% lidocaine: the impact of needle type.
BACKGROUND
The reported incidence of transient neurological symptoms (TNS) after subarachnoid lidocaine administration is as high as 40%. We designed this clinical trial to determine the incidence of TNS with two different pencil-point spinal needles: one-orifice (Atraucan) and two-orifice (Eldor) spinal needles.


METHODS
Ninety-nine ASA physical status I or II patients undergoing surgical procedures of the urinary bladder or prostate were prospectively allocated to receive spinal anesthesia with 40 mg, 2% isobaric lidocaine plus fentanyl injected through either a 26-gauge Atraucan (n = 52) or a 26-gauge Eldor (n = 47) spinal needle. During the first three postoperative days, patients were observed for postoperative complications, including TNS. The primary end-point for this trial was the percentage of TNS in both double- and single-orifice spinal needle procedures.


RESULTS
The incidence of TNS was higher when spinal anesthesia was done through the Atraucan needle (28.8% vs 8.5%, P = 0.006). Fifty percent of the patients in the double-orifice group versus 100% of the single-orifice group developed TNS after surgery in the lithotomy position (P = 0.014). The relative risk for developing TNS with the Eldor needle was 0.29 (95% CI: 0.07-0.75) compared with the Atraucan needle.


CONCLUSIONS
The use of a double-orifice spinal needle was associated with a lower incidence of TNS, which may have been due to the needle design.
Evron
Shmuel
S
bstetric Anesthesia Unit, and Department of Anesthesia, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Israel.
Gurstieva
Victoria
V
Ezri
Tiberiu
T
Gladkov
Vladimir
V
Shopin
Sergey
S
Herman
Amir
A
Sidi
Ami
A
Weitzman
Shimon
S
D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal / Q000009:adverse effects* / Q000295:instrumentation*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D004867:Equipment Design / Q000379:methods; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009339:Needles; D009422:Nervous System Diseases / Q000139:chemically induced / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000139:chemically induced / Q000209:etiology* / Q000517:prevention & control; D013346:Subarachnoid Space / Q000187:drug effects* / Q000473:pathology
D000779:Anesthetics, Local; D008012:Lidocaine