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AMBULATORY ANESTHESIA

Minidose Lidocaine-Fentanyl Spinal Anesthesia in Ambulatory Surgery: Prophylactic Nalbuphine Versus Nalbuphine Plus Droperidol

Bruce Ben-David, MD^*, Patrick J. DeMeo, MD, Christen Lucyk, RN ADN^*, and David Solosko, MD^*

Departments of *Anesthesiology and Orthopedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania

Address correspondence to Bruce Ben-David, MD, Department of Anesthesia, Allegheny General Hospital, 320 East North Ave., Pittsburgh, PA 15212. Address e-mail to b.bendavid{at}verizon.net Reprints will not be available from the authors.

Minidose lidocaine-fentanyl spinal anesthesia (SAB_MLF) is a safe, effective, and efficient anesthetic for ambulatory surgery. Unfortunately, it has a frequent incidence of pruritus and a substantial incidence of nausea and vomiting. Nalbuphine is effective in treating or preventing pruritus after intrathecal or epidural morphine but may or may not have a beneficial effect on nausea and vomiting. Droperidol has demonstrated antiemetic efficacy with neuraxial opiates. In this study, we examined the prophylactic use of nalbuphine alone compared with nalbuphine with droperidol after SAB_MLF. One-hundred-twenty-four patients having outpatient knee arthroscopy under SAB_MLF with 20 mg of lidocaine 0.5% and 20 µg of fentanyl were randomized to receive IV at the end of surgery either 4 mg of nalbuphine (Group N) or droperidol 0.625 mg plus nalbuphine 4 mg (Group ND). The incidences of early (before discharge) and late onset nausea were, respectively, 18% versus 5% and 32% versus 13%. The postoperative incidences of pruritus were 61% versus 40%, whereas 19% of patients in Group N compared with 2% of patients in Group ND requested treatment for this. Group ND had lower pain scores and had a longer delay until first use of analgesic. There were no differences in average times to discharge. The only side effect of the medications was an increased drowsiness in Group ND. In conclusion, as prophylactic medication for use in conjunction with SAB_MLF, the addition of droperidol 0.625 mg to nalbuphine 4 mg was superior to nalbuphine alone. The combination provided for reduced postoperative nausea, pruritus, and pain—benefits that persisted after discharge home. The combination also avoided isolated cases of extreme delay in discharge.

IMPLICATIONS: Droperidol in combination with nalbuphine enhances analgesia and is more effective than nalbuphine alone in preventing pruritus, nausea, and vomiting after minidose lidocaine-fentanyl spinal anesthesia.

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