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REGIONAL ANESTHESIA AND PAIN MANAGEMENT

Sameridine Is Safe and Effective for Spinal Anesthesia: A Comparative Dose-Ranging Study with Lidocaine for Inguinal Hernia Repair

Michael F. Mulroy, MD^*, Roy Greengrass, MD, Sugantha Ganapathy, MD, Vincent Chan, MD^§, and Agneta Heierson, PhD^||

Departments of Anesthesiology, *Virginia Mason Medical Center, Seattle Washington; Duke University Medical Center, Durham, North Carolina; Health Science Center, London, Ontario; §Toronto Western Hospital, Toronto, Ontario, Canada; and ||Astra Pain Control, Sodertalje, Sweden

Address correspondence and reprint requests to Michael F. Mulroy, MD, Virginia Mason Medical Center, 1100 9th Ave., PO Box 900, Seattle, WA 98101.

Sameridine is a new compound with local anesthetic and analgesic properties when injected intrathecally. We studied the anesthetic and analgesic efficacy of three doses of isobaric sameridine (15, 20, and 23 mg) compared with 100 mg of hyperbaric lidocaine for spinal anesthesia in 140 healthy male patients undergoing inguinal hernia repair. Patients received spinal anesthesia with 4 mL of the study drug injected at the L2-3 or L3-4 interspace in the lateral decubitus position. All three doses of sameridine provided spinal anesthesia similar to lidocaine, with a slightly longer time to reach peak block height. The failure rate was highest in the 15-mg sameridine group, and accrual was discontinued in that group after 35 patients. The duration of blockade was shorter with lidocaine, but the time to voiding and ambulation was similar in all groups. Patients receiving sameridine were less likely to request morphine for postoperative analgesia and were less likely to request any analgesia in the first 4 h after injection of the drug. Use of oral analgesics (hydrocodone and acetaminophen) was similar in all groups after the first 4 h of the 24-h observation. We conclude that, in the three doses studied, sameridine provided spinal anesthesia similar to lidocaine, but with residual analgesia after drug injection that reduced the need for systemic analgesics in the first 4 h postoperatively.

Implications: In this clinical trial, we show the potential efficacy of a class of drugs that can produce both spinal anesthesia and postoperative analgesia when used for hernia repair.

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