H. Vaghadia et al., SMALL-DOSE HYPOBARIC LIDOCAINE-FENTANYL SPINAL-ANESTHESIA FOR SHORT-DURATION OUTPATIENT LAPAROSCOPY .1. A RANDOMIZED COMPARISON WITH CONVENTIONAL-DOSE HYPERBARIC LIDOCAINE, Anesthesia and analgesia, 84(1), 1997, pp. 59-64
A randomized, single-blind trial of two spinal anesthetic solutions fo
r outpatient laparoscopy was conducted to compare intraoperative condi
tions and postoperative recovery. Thirty women (ASA physical status I
and II) were assigned to one of two groups. Group I patients received
a small-dose hypobaric solution of 1% lidocaine 25 mg made up to 3 mt
by the addition of fentanyl 25 mu g. Group II patients received a conv
entional-dose hyperbaric solution of 5% lidocaine 75 mg (in 7.5% dextr
ose) made up to 3 mt by the addition of 1.5 mt 10% dextrose. All patie
nts received 500 mt of crystalloid preloading. Spinal anesthesia was p
erformed at L2-3 or L3-4 with a 27-gauge Quincke point needle. Surgery
commenced when the level of sensory anesthesia reached T-6. Intraoper
ative hypotension requiring treatment with ephedrine occurred in 54% o
f Group II patients but not in any Group I patients. Median (range) ti
me for full motor recovery was 50 (0-95) min in Group I patients compa
red to 90 (50-120) min in Group II patients (P = 0.0005). Sensory reco
very also occurred faster in Group I patients (100 +/- 22 min) compare
d with Group II patients (140 +/- 27 min, P = 0.0001). Postoperative h
eadache occurred in 38% of all patients and 70% of these were postural
in nature. Oral analgesia was the only treatment required. Spinal ane
sthesia did not result in a significant incidence of postoperative bac
kache. On follow-up, 96% said they found spinal needle insertion accep
table, 93% found surgery comfortable, and 90% said they would request
spinal anesthesia for laparoscopy in future. Overall, this study found
spinal anesthesia for outpatient laparoscopy to have high patient acc
eptance and a comparable complication rate to other studies. The small
-dose hypobaric lidocaine-fentanyl technique has advantages over conve
ntional-dose hyperbaric lidocaine of no hypotension and faster recover
y.