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Prolongation of Lidocaine Spinal Anesthesia with Epinephrine and Phenylephrine

Received from the Departments of Anesthesiology and Clinical Investigation, Naval Hospital, San Diego, California.

Abstract

The effect of vasoconstrictors on the duration of lidocaine spinal anesthesia is controversial. We conducted a double-blind study of 28 neurologically normal ASA Class I or II patients to determine the effect of vasoconstrictors (epinephrine and phenylephrine) on the duration of lidocaine spinal anesthesia. The patients were randomized into three groups. All patients received 1.2 mg lidocaine per inch body height, mixed with 0.5 ml of test solution. Group 1 patients received lidocaine plus 0.5 ml normal saline; Group 2 patients received lidocaine plus 0.3 mg epinephrine; Group 3 patients received lidocaine plus 5 mg phenylephrine. Segmental sensory blockade was assessed by pinprick at 2-min intervals for the first 20 min and then every 5 min thereafter. Mean highest level was between T-2 and T-3 for all 3 groups. Time from injection to highest sensory level was similar in Groups 1 and 3, 11.6 ± 3.57 and 12.0 ± 5.10 min, respectively, but was significantly prolonged in Group 2, 18.1 ± 4.33 min. Time for regression by two sensory dermatomes were significantly prolonged in both Groups 2 and 3, 102.9 ± 18.1 and 105.7 ± 33.1 min, respectively, compared to 78.1 ± 12.6 min in Group 1. Times for regression to T-12 was also significantly prolonged in both Groups 2 and 3, 153.7 ± 27.6 and 156.8 ± 26.7 min, respectively, compared to 117.71 ± 10.0 min in Group 1. In the doses used in the present study, both epinephrine and phenylephrine significantly prolong the duration of lidocaine spinal anesthesia.

Key Words: ANESTHETIC TECHNIQUES—spinal

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