Lidocaine spinal

De la Calle JL, Palino CL (2002) A procedure for direct lumbar puncture in rats. Brain Res Bull 59 245-250 Denson DD, Bridenbaugh PO, Phero JC et al. (1981) Evaluation of lidocaine spinal anesthesia in the Rhesus monkey. Anesth Analg 10 756-759... 

Ben-David B, Maryanovsky M, Gurevitch A, Lucyk C, Solosko D, Frankel R, Volpin G, DeMeo PJ. A comparison of minidose lidocaine-fentanyl and conventional-dose lidocaine spinal anesthesia. Anesth Analg 2000 91(4) 865-70. 

Morisaki H, Masuda J, Kaneko S, Matsushima M, Takeda J. Transient neurologic syndrome in one thousand forty-five patients after 3% lidocaine spinal anesthesia. Anesth Analg 1998 86(5) 1023-6. 

Nelson CP, Francis TA, Wolf JS Jr. Comparison of shockwave lithotripsy outcomes in patients receiving sufentanil or lidocaine spinal anesthesia. J Endourol 2001 15(5) 473-7. 

Lidocaine hydrochloride [73-78-9] (Xylocaine), is the most versatile local anesthetic agent because of its moderate potency and duration of action, rapid onset, topical activity, and low toxicity. Its main indications are for infiltration, peripheral nerve blocks, extradural anesthesia, and in spinal anesthesia where a duration of 30 to 60 min is desirable. Because of its vasodilator activity, addition of the vasoconstrictor, epinephrine, increases the duration of action of Hdocaine markedly. It is also available in ointment or aerosol preparations for a variety of topical appHcations. 

The primary site of action of epidurally administered agents is on the spinal nerve roots. As with spinal anesthesia, the choice of drug to be used is determined primarily by the duration of anesthesia desired. However, when a catheter has been placed, short-acting drugs can be administered repeatedly. Bupivacaine is typically used when a long duration of surgical block is needed. Lidocaine is used most often for intermediate length procedures chloroprocaine is used when only a very short duration of anesthesia is required. 

Spinal anesthesia Spinal anesthesia is the introduction of local anesthetics directly into the spinal fluid, which causes a sympathetic blockage, or loss of feeling as well as muscle relaxation resulting from the interaction of anesthetic with every spinal nerve tract. This method is used during major surgical interventions. As a rule, lidocaine, mepivacaine, and bupivacaine are used for this purpose. 

Epidural anesthesia This term is understood to be an introduction of local anesthetic into the spinal cord membrane of the intervertebral space. It is used during obstetrical and gynecological interventions that do not require a fast development of anesthesia. Drugs such as lidocaine, mepivacaine, bupivacaine, ethidocaine, and chloroprocaine are used for this purpose. 

Lidocaine is the most widely used local anesthetic. Its excellent therapeutic activity is fast-acting and lasts sufficiently long to make it suitable for practically any clinical use. It stabilizes cell membranes, blocks sodium channels, facilitates the secretion of potassium ions out of the cell, and speeds up the repolarization process in the cell membrane. It is used for terminal infiltration, block, epidural, and spinal anesthesia during operational interventions in dentistry, otolaryngology, obstetrics, and gynecology. It is also used for premature ventricular extrasystole and tachycardia, especially in the acute phase of cardiac infarction. Synonyms for this drug are xylocaine, neflurane, and many others. 

Lidocaine hydrochloride Xylocaine) is the most commonly used local anesthetic. It is well tolerated, and in addition to its use in infiltration and regional nerve blocks, it is commonly used for spinal and topical anesthesia and as an antiarrhythmic agent (see Chapter 16). Lidocaine has a more rapidly occurring, more intense, and more prolonged duration of action than does procaine. 

Lidocaine is used for all forms of infiltration anaesthesia, in addition to peripheral, regional, spinal and epidural block. Unlike bupivacaine, it is suitable for use in intravenous regional anaesthesia. Duration of anaesthesia is about 1 hour but this can be prolonged to 2 hours by the addition of adrenaline. The maximum doses are shown in Table 5.2. 

The choice of local anesthetic for infiltration, peripheral nerve blocks, and central neuraxis (spinal/epidural) blockade is usually based on the duration of action required. Procaine and chloroprocaine are short-acting lidocaine, mepivacaine, and prilocaine have an intermediate duration of action and tetracaine, bupivacaine, levobupivacaine, and ropivacaine are long-... 

Lidocaine Blockade of sodium channels Slows, then blocks action potential propagation Short-duration procedures epidural, spinal anesthesia Parenteral duration 30-60 min 2-6 h with epinephrine Toxicity CNS excitation... 

Clinical use Mepivacaine has been employed for all types of infiltration and conduction nerve block anesthesia using solutions of 1.0 and 1.5 % lasting for 1.5 to 3 h. Epidural anesthesia with 2.0 % mepivacaine has a rapid onset with a dense motor block. Hyperbaric solutions of mepivacaine have also been used for spinal anesthesia (Tetzlaff, 2000). Mepivacaine has been used for topical applications, but other LA such as lidocaine are more effective. 

Farkas, S., Kocsis, P., Bielik, N. Comparative characterisation of the centrally acting muscle relaxant RGH-5002 and tolperisone and of lidocaine based on their effects on rat spinal cord in vitro, Neurobiology 1997, 5, 57-58. 

The action of several anesthetics has also been associated with a modulation of K+ channels. In addition to blocking Na+ currents in spinal neurones of the superficial dorsal horn the local anesthetics bupivacaine, lidocaine and mepivacaine reduce transient, A-type K+ currents in these cells whereas delayed rectifier K+ currents proved to be resistant (Olschewski et al., 1998). Since the A-type K+ current determines the frequency pattern of repetitively firing neurones (Hille, 2001) their suppression in dorsal... 

The most important adverse effect of capsaicin is the initial burning sensation that it produces. Intravesical capsaicin induces intense suprapubic pain during intravesical instillation that may be made tolerable by lidocaine in some but not all patients. Capsaicin also frequently causes a transient worsening of the urinary conditions before improvement of symptoms due to desensitization of bladder afferents becoming evident. In patients with high spinal cord lesions capsaicin might provoke life-threatening autonomic dysreflexia. 

Lidocaine Xylocaine Rapid Intermediate Infiltration Peripheral Nerve Block Epidural Spinal Transdermal Topical Sympathetic block Intravenous regional block... 

Lidocaine is effective in producing analgesia when administered by infiltration, or by nerve, epidural, caudal, and spinal block. In addition, it is effective when applied topically, with an onset of action of 5 min and a duration of action of 15 to 30 min. Lidocaine (1.5 pg/ml) is the agent of choice for the acute suppression of most ventricular arrhythmias. 

Bupivacaine is long-acting 3 h) (see Table 18.1) and is used for peripheral nerve blocks, and epidural and spinal anaesthesia. Whilst onset of effect is comparable to lidocaine, peak effect occurs later (30 min). 

Kaukinen S, Eerola R, Eerola M, Kaukinen L. A comparison of carticaine and lidocaine in spinal anaesthesia. Ann Clin Res 1978 10(4) 191-4. 

Keld DB, Hein L, Dalgaard M, Krogh L, Rodt SA. The incidence of transient neurologic symptoms (TNS) after spinal anaesthesia in patients undergoing surgery in the supine position. Hyperbaric lidocaine 5% versus hyperbaric bupivacaine 0.5%. Acta Anaesthesiol Scand 2000 44(3) 285-90. 

Prophylactic nalbnphine 4 mg and droperidol 0.625 mg with minidose lidocaine + fentanyl spinal anesthesia in a randomized, double-blinded, controlled stndy in 62 patients having outpatient knee arthroscopy provided significantly better analgesia and rednced nansea and pmritns than in another 62 patients who received only nalbnphine 4 mg with minidose lidocaine + fentanyl spinal anesthesia (71). 

Ben-David B, DeMeo PJ, Lucyk C, Solosko D. A comparison of minidose lidocaine-fentanyl spinal anesthesia and... 

Life-threatening bronchospasm can occur after either spinal or topical use of lidocaine. In one series of patients being treated with lidocaine spray 40 mg for persistent cough, there was an increase of airway resistance (SED-12, 255) (22). 

Jensen E, Nader ND. Potentiation of narcosis after intravenous lidocaine in a patient given spinal opioids. Anesth Analg I999 89(3) 758-9. 

A 74-year-old man who had a cystoscopy performed in the lithotomy position, reported dull pain in the hips, buttocks, and legs, radiating to the toes after a spinal anesthetic with 5% hyperbaric lidocaine 75 mg. The pain occurred 30 hours after the dural puncture and... 

In a prospective study of 1045 patients receiving spinal anesthesia with 3% hyperbaric lidocaine for anorectal... 

In a retrospective audit of 363 patients receiving spinal anesthesia, of whom 322 received hyperbaric 5% lidocaine 75-100 mg and 41 hyperbaric 0.5% bupivacaine 12.5-15 mg, six patients given lidocaine reported back pain at 24 hours five of them had undergone arthroscopy. One patient given bupivacaine, who underwent arthroscopy, complained of backache (233). 

The incidence of transient radicular irritation with two different local anesthetics used for single-dose spinal anesthesia has been studied in 60 ambulatory patients given spinal anesthesia for knee arthroscopy (235). None of those who were given 1.5% mepivacaine 45 mg developed transient radicular irritation. Six of those given 2% lidocaine 60 mg developed transient radicular irritation, but all symptoms resolved by 1-5 days. The difference between the two groups was significant. 

When 90 patients received spinal anesthesia for gynecological procedures with 2% hdocaine, 2% prUocaine, or 0.5% bupivacaine (all 2.5 ml in 7.5% glucose), nine of the 30 patients who received lidocaine had transient radicular irritation, defined as pain or dysesthesia in the legs or buttocks, compared with none of the 30 patients who received bupivacaine (236). The symptoms resolved within 48 hours. One of the 30 patients who received prilocaine had transient radicular irritation that lasted for 4 days. 

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