Selective spinal anesthesia for outpatient laparoscopy. II: Epinephrine and spinal cord function

Purpose: To compare two small-dose solutions (with and without: epinephrine ) for spinal anesthesia during outpatient laparoscopy and to determine spin al cord function with these low-dose solutions. Method: Twenty outpatients undergoing gynecological laparoscopy were random ly assigned to receive spinal anesthesia with one of two low dose solutions . Group LS- 10 mg lidocaine plus 10 mug sufentanil; Group LSE- 10 mg lidoca ine plus 10 mug sufentanil plus epinephrine 50 mug. Solutions were diluted to three millilitres with sterile water for injection. A 27-gauge Whitacre needle was inserted at L2-3 or L3-4 in the sitting position. Operating cond itions and spinal cord function (spinothalamic, dorsal column and motor) we re assessed. Results: Operating conditions were good - excellent in both groups. The inc idence of shoulder tip discomfort, pruritus and nausea, and the amount of s upplementation with alfentanil and midazolam was not different between grou ps. Most patients in both groups had preserved dorsal column function and n ormal motor power on arrival in PACU and were able to satisfy 'walk out' cr iteria. Recovery of pinprick sensation and discharge times were not differe nt. Mild pruritus (VAS score less than or equal to 5)was present in both gr oups. Conclusion: For short duration laparoscopy, addition of 50 mug epinephrine to a small dose of spinal 10 mg lidocaine with 10 mug sufentanil did not pr ovide additional benefit in terms of intraoperative analgesia or operating conditions. Spinal cord function was preserved with small-dose techniques.