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AMBULATORY ANESTHESIA

Subarachnoid Small-Dose Bupivacaine Versus Lidocaine for Cervical Cerclage

Yaakov Beilin, MD^*,, Jeffrey Zahn, MD^*, Sharon Abramovitz, MD, Howard H. Bernstein, MD^*,, Sabera Hossain, MS, and Carol Bodian, DrPH

Departments of *Anesthesiology, Obstetrics, Gynecology, and Reproductive Sciences, and Biomathematical Sciences, Mount Sinai School of Medicine, New York University, New York, New York; and Department of Anesthesiology, Weill Medical College of Cornell University, New York, New York

Address correspondence and reprint requests to Yaakov Beilin, MD, Mount Sinai School of Medicine, Department of Anesthesiology, Box 1010, One Gustave L. Levy Place, New York, NY 10029-6574. Address e-mail to Yaakov.Beilin{at}mountsinai.org

Cervical cerclage is often performed as an outpatient procedure under subarachnoid anesthesia. Lidocaine was historically the drug of choice for short procedures but has fallen out of favor because of concerns of transient neurologic symptoms (TNS). We performed this study to determine whether small-dose bupivacaine is an acceptable alternative to lidocaine for cervical cerclage. We randomized 59 women to receive either subarachnoid isobaric lidocaine 30 mg or hyperbaric bupivacaine 5.25 mg. Fentanyl 20 µg was added to both local anesthetics, and the total volume was diluted to 3 mL with 0.9% saline. Onset and highest dermatomal level of sensory block; quality of anesthesia; hypotension; and times until T12 regression, return of lower extremity motor function, ambulation, and micturition were recorded. Symptoms of TNS were evaluated by telephone interview 24 h after surgery. We did not find any significant difference in onset or recovery times between the groups, with the exception of a longer duration until return of lower extremity motor strength in the lidocaine group. Symptoms consistent with TNS that resolved spontaneously within 48 h were reported by two women in the lidocaine group but by none in the bupivacaine group. We conclude that subarachnoid bupivacaine offers a satisfactory alternative to subarachnoid lidocaine for cervical cerclage.

IMPLICATIONS: We found that small-dose subarachnoid bupivacaine (5.25 mg) with fentanyl 20 µg provides reliable anesthesia for cervical cerclage and exhibits a pharmacodynamic profile similar to that of small-dose lidocaine.

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