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REGIONAL ANESTHESIA

Transient Neurological Symptoms After Isobaric Subarachnoid Anesthesia with 2% Lidocaine: The Impact of Needle Type

Shmuel Evron, MD^*, Victoria Gurstieva, RN, MPH, Tiberiu Ezri, MD, Vladimir Gladkov, MD, Sergey Shopin, MD, Amir Herman, MSc^||, Ami Sidi, MD^¶, and Shimon Weitzman, MD, MPH

From the *Obstetric Anesthesia Unit, and Department of Anesthesia, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Israel; Outcomes Research Group, Cleveland, Ohio; Department of Epidemiology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva; ||Department of Statistics, Haifa University; and ¶Department of Urology, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Israel.

Address correspondence and reprint requests to Tiberiu Ezri, MD, Department of Anesthesia, Wolfson Medical Center, Holon 58100, Israel. Address e-mail to tezri{at}netvision.net.il.

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.

This article has been cited by other articles:

				S. Evron and T. Ezri The Use of Lidocaine for Spinal Anesthesia Anesth. Analg., May 1, 2008; 106(5): 1587 - 1587. [Full Text] [PDF]

				S. M. Neustein The Use of Lidocaine for Spinal Anesthesia Anesth. Analg., May 1, 2008; 106(5): 1586 - 1587. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999