Anesthetic and recovery profiles of lidocaine versus mepivacaine for spinal anesthesia in patients undergoing outpatient orthopedic arthroscopic procedures

• Published in: Journal of clinical anesthesia Vol. 24; no. 2; pp. 109 - 115
• Main Authors: Pawlowski, Julius, MD, Orr, Kevin, DO, Kim, Ku-mie, MD, PhD, Pappas, Ana Lucia, MD, Sukhani, Radha, MD, Jellish, W. Scott, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2012; Elsevier Limited
• Subjects: Academic Medical Centers; Adolescent; Adult; Aged; Ambulatory surgery; Ambulatory Surgical Procedures - methods; Anesthesia; Anesthesia & Perioperative Care; Anesthesia Recovery Period; Anesthesia, Epidural - methods; Anesthesia, Spinal - methods; Anesthetics, Local - administration & dosage; Anterior cruciate ligament repair; Arthroscopy - methods; Back pain; Confidence intervals; Data collection; Double-Blind Method; Femoral Nerve; Humans; Knee Joint - surgery; Lidocaine - administration & dosage; Mepivacaine - administration & dosage; Middle Aged; Nerve Block - methods; Pain Medicine; Prospective Studies; Spinal anesthetics; Studies; Surgery; Time Factors; TNS symptoms; Young Adult; TNS symptoms; Ambulatory surgery; Spinal anesthetics; Anterior cruciate ligament repair
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2011.06.014

Abstract Study Objective To compare isobaric lidocaine and mepivacaine in outpatient arthroscopic surgery. Design Prospective, randomized, double-blinded study. Setting Ambulatory surgery center affiliated with an academic tertiary-care hospital. Patients 84 adult, ASA physical status 1, 2, and 3 ambulatory patients, age 18-70 years, undergoing arthroscopic knee surgery. Intervention Patients were randomized to receive a combination spinal-epidural anesthetic using 80 mg of either isobaric 2% mepivacaine or isobaric 2% lidocaine. Patients also received a femoral 3-in-1 block with 0.5% bupivacaine applied to the affected extremity. Measurements Demographic data and level and duration of the block were recorded. The use of supplemental epidural anesthesia was noted along with frequency of bradycardia, hypotension, and episodes of nausea and vomiting. Duration of block and times to ambulation and voiding were recorded. Delayed variables, including fatigue, difficulty urinating, back pain, and transient neurologic symptoms (TNS) were obtained. Main Results No demographic differences were noted between groups, and surgical duration was similar. Satisfactory anesthesia was achieved in all cases, with no differences noted in hypotension, bradycardia, nausea, or vomiting. Onset of sensory and motor block was similar. Duration of block before epidural supplementation was 94 ± 21 minutes with lidocaine versus 122 ± 23 minutes for mepivacaine ( P < 0.011). Times to ambulation and voiding were longer in patients receiving mepivacaine but did not affect PACU stay. Twenty-four and 48-hour recovery was similar with no TNS symptoms reported. Conclusion No major differences were noted between lidocaine and mepivacaine spinal anesthesia. Time to ambulation and voiding were longer in patients who received mepivacaine as was time to first dose of epidural catheter. Neither group had TNS symptoms. Lidocaine and mepivacaine are both appropriate spinal anesthetics for ambulatory orthopedic lower extremity procedures.