Prospective study on incidence and functional impact of transient neurologic symptoms associated with 1% versus 5% hyperbaric lidocaine in short urologic procedures

Anesthesiology. 2003 Feb;98(2):485-94. doi: 10.1097/00000542-200302000-00030.

Abstract

Background: The objectives of this study were to compare the incidence, onset, duration and pain scores of transient neurologic symptoms (TNS) with 1% versus 5% hyperbaric lidocaine in spinal anesthesia for short urological procedures in a large prospective study. This study would also evaluate patient satisfaction, and impact of TNS on functional recovery to assess the clinical significance of TNS.

Methods: This was a multicenter, double-blind, randomized controlled trial. Four hundred fifty-three patients undergoing short transurethral procedures were randomized to receive 1% or 5% hyperbaric lidocaine. Eighty milligrams of 1% or 5% hyperbaric lidocaine was administered. During the first 3 days after surgery, the presence of TNS, its intensity and duration, and patient functional level were recorded. An intention-to-treat analysis was used.

Results: There was no difference in the incidence of TNS (21% vs. 18%) between 1% versus 5% lidocaine. Patients with TNS had significantly higher pain scores (5.3 +/- 3 vs. 2.3 +/- 3) than patients without TNS during the first 24 h. This difference in pain scores persisted until 72 h postoperatively. There was a significant difference in the daily activities functional scores (2.2 +/- 1 vs. 1.4 +/- 0.8) of TNS non-TNS patients during the first 24 h postoperatively.

Conclusions: There was no difference in the incidence of TNS between the 1% versus 5% spinal lidocaine groups. Pain scores were higher in patients with TNS than those who did not have TNS. During the first 48 h postop, a small proportion of patients who had TNS experienced functional impairment of walking, sitting, and sleeping.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetaminophen / administration & dosage
  • Acetaminophen / therapeutic use
  • Aged
  • Analgesics, Non-Narcotic / administration & dosage
  • Analgesics, Non-Narcotic / therapeutic use
  • Analgesics, Opioid / therapeutic use
  • Anesthesia, Spinal / adverse effects*
  • Anesthetics, Local / adverse effects*
  • Codeine / administration & dosage
  • Codeine / therapeutic use
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Drug Combinations
  • Female
  • Humans
  • Lidocaine / adverse effects*
  • Male
  • Morphine / therapeutic use
  • Neurotoxicity Syndromes / epidemiology*
  • Neurotoxicity Syndromes / psychology
  • Pain / prevention & control
  • Pain Measurement / drug effects
  • Pain, Postoperative / drug therapy
  • Pilot Projects
  • Postoperative Complications / chemically induced
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / psychology
  • Prospective Studies
  • Urologic Surgical Procedures*

Substances

  • Analgesics, Non-Narcotic
  • Analgesics, Opioid
  • Anesthetics, Local
  • Drug Combinations
  • Acetaminophen
  • Morphine
  • Lidocaine
  • Codeine