Canadian Journal of Anaesthesia

, Volume 45, Issue 7, pp 645–650 | Cite as

Dose response study of lidocaine 1% for spinal anaesthesia for lower limb and perineal surgery

  • Beng-Ling Liam
  • Cik-Foo Yim
  • Jin-Long Chong
Reports of Investigation

Abstract

Purpose

To compare the sensory and motor block produced by three different volumes of intrathecal lidocaine 1% and thereby determine the appropriate volume to administer for surgery of the lower limbs and perineum.

Methods

Forty-eight patients scheduled for perineal or lower limb surgery were randomly assigned to receive 4, 6 or 8 ml lidocaine 1% intrathecally. The onset, spread, duration and regression of analgesia and motor block and side effects were evaluated (by a blinded observer whenever possible).

Results

The maximum cephalad spread in the 6 ml (T8 ± 3) and 8 ml (T4 ± 1.7) groups were higher than the 4 ml group (T12 ± 2.2,P < 0.01). In the 4 ml group, six patients (33%) did not achieve analgesia to T12 and four (22%) did not have complete motor blockade. Patients given 8 ml had longer duration of block (duration at T12: 104 ± 23vs 60 ± 24, 67 ± 14 min,P < 0.01; 8 mlvs 4, 6 ml) and slower recovery times (sensory recovery: 188 ± 27vs 142 ± 27, 157 ± 28 min,P < 0.01; 8 mlvs 4, 6 ml). Two patients (18%) from the 8 ml group and one (5%) from the 6 ml group had transient hypotension.

Conclusion

Four millilitres intrathecal lidocaine 1% is adequate for perineal surgery but for lower limb procedures, 6 ml is more appropriate as it consistently provides sensory analgesia above L1 dermatome and complete motor block. Eight ml gives an unnecessarily high block with higher incidence of hypotension.

Résumé

Objectif

Comparer le blocage sensitif et moteur produit par trois différents volumes de lidocaïne intrathécale à 1% et déterminer ainsi le volume approprié pour une chirurgie des membres inférieurs et du périnée.

Méthode

Quarante-huit patients devant subir une chirurgie des membres inférieurs ou du périnée ont été choisis au hasard pour recevoir 4, 6 ou 8 ml de lidocaïne intrathécale à 1%. Le début, l’étendue, la durée et la régression de l’analgésie et du blocage moteur et les effets secondaires ont été évalués (par un observateur impartial autant que possible).

Résultats

Dans les groupes ayant reçu 6 ml (T8 ± 3) ou 8 ml (T4 ± 1,7) l’extension maximale en direction céphalique a été plus haute que dans le groupe ayant reçu 4 ml (T12 ± 2,2;P < 0,01). Dans le groupe à 4 ml, chez six patients (33%) l’analgésie n’a pas atteint T12 et quatre (22%) n’ont pas eu de blocage moteur complet. Les patients à qui on a donné 8 ml ont eu un blocage de plus longue durée (durée à T12: 104 ± 23vs 60 ± 24, 67 ± 14 min,P < 0,01; 8 mlvs 4, 6 ml) et une récupération plus lente (récupération sensitive: 188 ± 27vs 142 ± 27, 157 ± 28 min,P < 0,01; 8 mlvs 4, 6 ml). Deux patients (18%) du groupe à 8 ml et un (5%) du groupe à 6 ml ont eu de l’hypotension transitoire.

Conclusion

Quatre millilitres de lidocaïne intrathécale à 1% constituent une dose appropriée pour une chirurgie du périnée, mais pour une intervention aux membres inférieurs, 6 ml sont plus efficaces, puisqu’ils fournissent régulièrement une analgésie sensorielle au-dessus du dermatome de L1 et un blocage moteur complet. Huit millilitres produisent un blocage inutilement haut accompagné d’une plus grande incidence d’hypotension.

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Copyright information

© Canadian Anesthesiologists 1998

Authors and Affiliations

  • Beng-Ling Liam
    • 1
  • Cik-Foo Yim
    • 1
  • Jin-Long Chong
    • 1
    • 2
  1. 1.Department of AnaesthesiaTan Tock Seng HospitalSingaporeRepublic of Singapore
  2. 2.Department of AnaesthesiaKandang Kerbau HospitalSingapore

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