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LETTER TO THE EDITOR

The Use of Lidocaine for Spinal Anesthesia

Department of Anesthesiology; The Mount Sinai Medical Center; One Gustave L. Levy Place; New York City, New York; steve.neustein{at}msnyuhealth.org

To the Editor:

A recent paper clearly demonstrated a substantial reduction in the incidence of transient neurological symptoms (TNS) in patients undergoing spinal anesthesia with 2% lidocaine when using the double orifice spinal needle, compared with the single-orifice needle.1 However, even with the double-orifice needle, there was still an unacceptably high incidence of TNS, presumably because of lidocaine. It has been previously shown that lidocaine is associated with a higher incidence of TNS than other local anesthetics, such as bupivacaine.2,3 The use of bupivacaine, however, will delay recovery. Additionally, there may be a higher failure rate with small-dose spinal bupivacaine.4

Not mentioned in the paper is whether the patients were informed in the consenting process that lidocaine is associated with the greatest incidence of TNS, and that there are local anesthetics associated with a lower incidence of TNS. The choice of local anesthetic and this specific issue of consent should have been discussed in the report. Lidocaine is no longer used for spinal anesthesia in our institution, because of the increased risk of TNS.

REFERENCES

1. Evron S, Gurstieva V, Ezri T. Transient neurological symptoms after isobaric subarachnoid anesthesia with 2% lidocaine: the impact of needle type. Anesth Analg 2007;105:1494–9[Abstract/Free Full Text]
2. Pollock JE, Liu SS, Neal JM, Stephenson CA. Dilution of spinal lidocaine does not alter the incidence of transient neurological symptoms. Anesthesiology 1999;90:445–50[Web of Science][Medline]
3. Freedman JM, Li DK, Drasner K, Jaskela MC, Larsen B, Wi S. Transient neurologic symptoms after spinal anesthesia. Anesthesiology 1998;89:633–41[Web of Science][Medline]
4. Carron M, Freo U, Veronese S, Innocente F, Ori C. Spinal block with 1.5 mg hyperbaric bupivacaine: not successful for everyone. Anesth Analg 2007;105:1515–6[Free Full Text]

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