Letters to the Editor: Letters & Announcements
Dr. Neustein1 raises important concerns regarding the use of lidocaine for spinal anesthesia. The increasing number of day surgery cases requires availability of a short-acting, yet safe, local anesthetic if spinal anesthesia is employed in outpatients and no one drug meets all requirements. For example, bupivacaine may be less suitable for day surgery procedures because of its greater failure rate, prolonged effect,2 and reportedly greater incidence of urinary retention, and chlorprocaine is not approved for use in spinal anesthesia.
Small-dose spinal lidocaine (15 mg), combined with 10 μg sufentanil, is associated with a very low incidence of transient neurological symptoms (TNS).3 In the consenting process, our patients were informed of the advantages and disadvantages of local anesthetics, including the incidence of TNS with different local anesthetics and different needles.
As we explained in the manuscript, for ethical reasons, the study was not completed because of the high incidence of TNS.
In conclusion, we do not believe that the intrathecal administration of lidocaine should be abandoned, but rather the injection technique and dosage should be improved, as suggested by our and other studies.4,5
Shmuel Evron, MD
Tiberiu Ezri, MD
Department of Anesthesia
Wolfson Medical Center
1. Neustein SM. The use of lidocaine for spinal anesthesia. Anesth Analg 2008;106:1586–7
2. Carron M, Freo U, Veronese S, Innocente F, Ori C. Spinal block with 1.5 mg hyperbaric bupivacaine: not successful for everyone. Anesth Analg 2007;105:1515–6
3. Waxler B, Mondragon SA, Patel SN, Nedumgottil K. Intrathecal lidocaine and sufentanil shorten postoperative recovery after outpatient rectal surgery. Can J Anaesth 2004;51:680–4
4. Evron S, Gurstieva V, Ezri T, Gladkov V, Shopin S, Herman A, Sidi A, Weitzman S. Transient neurological symptoms after isobaric subarachnoid anesthesia with 2% lidocaine: the impact of needle type. Anesth Analg 2007;105:1494–9
5. Drasner K. Local anesthetic neurotoxicity. Clinical injury and strategies that may minimize risk. Reg Anesth Pain Med 2002;27:576–80