PROCAINE SPINAL-ANESTHESIA - A PILOT-STUDY OF THE INCIDENCE OF TRANSIENT NEUROLOGIC SYMPTOMS

Study Objectives: To determine the approximate incidence of transient neurologic symptoms (TNS) [formerly known as transient radicular irrit ation (TRI)] associated with procaine spinal anesthesia, and whether f entanyl prolongs the duration of procaine spinal anesthesia. Design: U nrandomized Pilot study. Setting: Community teaching hospital. Patient s: 106 consecutive patients scheduled for spinal anesthesia for proced ures anticipated to last less than 90 minutes. Interventions: All pati ents received 5% procaine for spinal anesthesia. Fentanyl 20 mu g was added for procedures anticipated to last longer than 45 minutes (but l ess than 90 min). Intraoperatively the adequacy of duration, Im,el, an d intensity of anesthesia were observed. Time from injection of local anesthetic until knee-bending was recorded. Three days postoperatively , patients were questioned intensively in an effort to determine wheth er back pain and/or symptoms consistent with TNS had occurred.. Measur ements and Main Results: Duration of anesthesia was adequate in ail bu t one instance. The intensity and the sensory level of anesthesia were satisfactory with one exception, a woman who had an unexpectedly low sensory level (LI) after 60 mg of procaine for cerclage, and who was a lso was the only patient to develop TNS. The incidence of TNS (0.9%) w as markedly less than that reported after lidocaine and similar to the incidence observed after bupivacaine, Mild back pain without radiatio n occurred in II patients (10%) an incidence that is similar to that s een after bupivacaine and lidocaine, Compared with procaine alone, the addition of fentanyl significantly (p = 0.0001) prolonged the fine to bending knees from 72 minutes to 97 minutes. Conclusions: Procaine ma y be a useful alternative to lidocaine for short procedures, and it is less likely to produce TNS. Fentanyl prolongs motor block when added to procaine. (C) 1998 by Elsevier Science Inc.