We share the concern about the risk of neurotoxicity of intrathecal articaine 40 mg ml−1 as outlined by Malinovsky1 in an invited Commentary in a recent issue of European Journal of Anaesthesiology. All local anaesthetics are neurotoxic when used at high concentrations, including, for instance, lidocaine.2 Thus, the common and logical aim of any regional anaesthetic activity is to use small doses and acceptably diluted solutions that retain clinical effectiveness.
In order to avoid any misunderstanding, we wish to point out that the articaine concentration used by us in our recent study,3 and referred to by Malinovsky,1 was not 40 but 30 mg ml−1. The dilution was the result of the addition of 0.7 ml glucose 300 mg ml−1 to the articaine solution. When fentanyl is used concomitantly with the hyperbaric articaine,4 the dilution is even greater. Additionally, we would like to correct a misinterpretation concerning patient satisfaction with the anaesthetic.1 In the postoperative interviews, in fact, patients in both study groups (articaine and bupivacaine–fentanyl) were either very satisfied (56%) or satisfied (44%) with their spinal anaesthetic without any differences between groups.3
The study was supported by Helsinki University Hospital research funds (EVO). There are no relevant conflicts of interest.
1. Malinovsky J-E. Is 4% articaine suitable for spinal anaesthesia? Eur J Anaesthesiol
2. Sakura A, Kirihara Y, Muguruma T, et al. The comparative neurotoxicity of intrathecal lidocaine and bupivacaine in rats. Anesth Analg
3. Bachmann M, Pere P, Kairaluoma P, et al. Randomised comparison of hyperbaric articaine and hyperbaric low-dose bupivacaine along with fentanyl in spinal anaesthesia for day case inguinal herniorrhaphy. Eur J Anaesthesiol
4. Kairaluoma PM, Bachmann M, Kallio H, et al. Intrathecal hyperbaric articaine plus fentanyl: better analgesia during and after inguinal herniorrhaphy without prolonging recovery from the block. Reg Anesth Pain Med