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AMBULATORY ANESTHESIA

The Anesthetic and Recovery Profile of Two Doses (60 and 80 mg) of Plain Mepivacaine for Ambulatory Spinal Anesthesia

Julius Pawlowski, MD^*, Radha Sukhani, MD^*, Ana L. Pappas, MD^*, Ku-Mie Kim, MD^*, Jordan Lurie, MD^*, Helena Gunnerson, MD^*, Andrea Corsino, RN, BSN^*, Kere Frey, DO^*, and Pietro Tonino, MD

Departments of *Anesthesiology and Orthopedics, Loyola University Medical Center, Maywood, Illinois

Address correspondence to Julius Pawlowski, MD, Department of Anesthesiology, Loyola University Medical Center, 2150 S. First Ave., Maywood, IL 60153.

Reports of transient neurological symptoms with the use of subarachnoid lidocaine has generated interest in alternate local anesthetics of intermediate duration, such as mepivacaine. This prospective randomized, double-blinded, dose-response study examined the anesthetic and recovery profiles of 60- and 80-mg doses of preservative-free plain mepivacaine for ambulatory spinal anesthesia. Sixty patients undergoing ambulatory anterior cruciate ligament repair of the knee under spinal anesthesia were randomized into two groups; Group 1 (29 patients) received 4 mL of 1.5% (60-mg dose) and Group 2 (31 patients) received 4 mL of 2% (80-mg dose) of plain mepivacaine. All patients received a combined spinal-epidural anesthetic technique. The epidural catheter was used only in the event the surgery outlasted the duration of surgical anesthesia with subarachnoid mepivacaine. Epidural supplementation was administered in three patients (12%) in Group 1 and one patient (3%) in Group 2 when the sensory block regressed to L-1 with surgery expected to last longer than 15 min. The cephalad dermatome level of the block and degree of motor block was comparable in the two groups. Times to two-segment and T-10 regression were comparable in the two groups (112 ± 26 min in Group 1 versus 122 ± 28 min in Group 2). Time to L-1 regression was significantly longer in Group 2 (146 ± 28 min in Group 1 versus 159 ± 19 min in Group 2). All of the ambulatory milestones were significantly faster in Group 1. Side effects, such as hypotension and emesis were negligible, severe bradycardia and urinary retention did not occur, and none of the patients in the two groups reported transient neurological symptoms over 24 h. In conclusion, plain mepivacaine in a 60- or 80-mg dose is a suitable local anesthetic choice for ambulatory spinal anesthesia with respect to anesthetic, as well as recovery profiles.

Implications: We evaluated the anesthetic and recovery profiles of 60- and 80-mg doses of plain mepivacaine for ambulatory spinal anesthesia. Both doses produced comparable sensory and motor block. Sensory and motor regression and ambulatory milestones were 20–30 min longer with the 80-mg dose. Side effects were negligible and transient neurological symptoms were not reported during a 24-h follow-up.

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