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AMBULATORY ANESTHESIA

Small-Dose Intrathecal Lidocaine Versus Ropivacaine for Anorectal Surgery in an Ambulatory Setting

Chester C. Buckenmaier, III, MD^*, Karen C. Nielsen, MD^*, Ricardo Pietrobon, MD^*, Stephen M. Klein, MD^*, Aliki H. Martin, RN^*, Roy A. Greengrass, MD^*, and Susan M. Steele, MD^*

Departments of *Anesthesiology and Surgery, Duke University Medical Center, Durham, North Carolina

Address correspondence and reprint requests to Chester C. Buckenmaier III, MD, Department of Anesthesiology, Box 3094, Duke University Medical Center, Durham, NC 27710. Address e-mail to bucke001{at}mc.duke.edu

Spinal anesthesia with the local anesthetic lidocaine has come under scrutiny because it is associated with transient neurologic symptoms (TNS). We designed this study to prospectively compare the efficacy of ropivacaine as an alternative to lidocaine in patients undergoing elective outpatient anorectal procedures. Seventy-two patients were randomized to receive either hyperbaric lidocaine 25 mg with fentanyl 20 µg (n = 37) or hyperbaric ropivacaine 4 mg with fentanyl 20 µg (n = 35). Patients were examined for motor block, sensory block, and block duration. Patients were contacted at 24, 48, 72, and 168 h and questioned about their perceptions of pain after the spinal with specific questions designed to diagnose TNS. There were no patients with TNS in either group. There was no significant difference between the lidocaine and ropivacaine groups in any of the outcomes studied. In conclusion, intrathecal hyperbaric small-dose ropivacaine with fentanyl is an acceptable anesthetic for anorectal surgery.

IMPLICATIONS: In this prospective trial, small-dose ropivacaine with fentanyl was as effective as small-dose lidocaine with fentanyl for anorectal procedures in the ambulatory setting.

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