SMALL-DOSE HYPOBARIC LIDOCAINE-FENTANYL SPINAL-ANESTHESIA FOR SHORT-DURATION OUTPATIENT LAPAROSCOPY .1. A RANDOMIZED COMPARISON WITH CONVENTIONAL-DOSE HYPERBARIC LIDOCAINE

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.