Selective spinal anesthesia for outpatient laparoscopy. I: Characteristicsof three hypobaric solutions

Purpose: To determine the characteristics and recovery profiles of three hy pobaric spinal anesthetic solutions. Methods: Thirty outpatients undergoing outpatient laparoscopy were randomly assigned to receive spinal anesthesia with one of three small-dose solutio ns. Group I - 20 mg lidocaine plus 25 mug fentanyl; Group II - 20 mg lidoca ine plus 10 mug sufentanil; Group III - 10 mg lidocaine plus 10 mug sufenta nil. Solutions were diluted to three ml with sterile water for injection, A 27-gauge Whitacre needle was inserted at L2-3 or L3-4 in the sitting posit ion. Sensory and motor recovery were assessed with pinprick. proprioception , light touch and a modified Bromage scale. Results: Operating conditions were good to excellent in all three groups. T he incidence of shoulder tip discomfort, pruritus and nausea was not signif icantly different between groups. Light touch was present in all three grou ps and proprioception was present in most patients during and after surgery . Group III patients had a more rapid recovery of pinprick analgesia and Gr oup II patients had the slowest recovery of pinprick analgesia, Motor block recovery was comparable in the three groups. Eighty percent of patients in Groups III and I were able to perform 'deep knee bends' and 'straight leg raises' at the end of surgery. Conclusion: For short duration laparoscopy, spinal 10 mg lidocaine with 10 mug sufentanil provided selective pin prick analgesia, with preserved touch , proprioception and limited motor block. Operating conditions were satisfa ctory and most patients were able to fulfill 'walk out' criteria at the end of surgery.