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SPINAL ANAESTHESIA IN THE SURGICAL DAY CASE CENTER: TECHNIQUE AND DRUG SELECTION
Author(s):
Teunkens, A.*
Affiliations:
UZ Leuven, Anesthesiology, Leuven, Belgium
ESRA Academy. Teunkens A. Sep 16, 2017; 196234
Topic: REGIONAL ANAESTHESIA (RA) IN SPECIFIC SUBPOPULATIONS
Dr. An Teunkens
Dr. An Teunkens
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Abstract
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Spinal anesthesia in the surgical day case center: technique and drug selection

 

In day-case surgery, a lot of procedures can be performed under spinal anesthesia. The short duration of these procedures and the high turnover in a day case center necessitate the performance of a neuraxial anesthesia with local anesthetics that exhibit fast onset and quick recovery kinetics.1

The pharmacokinetic profile of lidocaine is attractive but the high risk for transient neurologic symptoms (TNS) abandoned its routine use.2

Bupivacaine is widely used and has proven its safety, but the long duration of action may delay the recovery of motor function, cause urinary retention and may lead to a delayed discharge.3 A solution is lowering the dose of bupivacaine or using a unilateral block. Unfortunately by lowering the dose the incidence of failed blocks increases.

Therefore, the use of chloroprocaine, articaine and prilocaine are better alternatives.

Prilocaine has an intermediate duration of action and is available in a hyperbaric formula, which makes it possible to induce a unilateral block and to use it for more extended surgery without increasing the risk for a delayed recovery of the block. Nevertheless, some cases of TNS are described.4

Articaine provides a fast onset and a duration of action between prilocaine and chloroprocaine but is associated with a higher risk for intraoperative hypotension.5

Chloroprocaine is characterized by a rapid onset and quick recovery and its formulation without preservatives is no longer associated with neurotoxicity.6 The short duration of action lowers the risk of urinary retention, and together with the low risk for TNS, chloroprocaine is possible an ideal local anesthetic for short procedures under spinal anesthesia.

 

 

  1. Curr Opin Anaesthesiol. 2014;27(6):597-604. doi:10.1097/ACO.0000000000000126.
  2. Cochrane Database Syst Rev. 2009;(2):CD003006. doi:10.1002/14651858.CD003006.pub3.
  3. Br J Anaesth. 2009;102(3):307-315. doi:10.1093/bja/aen389.
  4. Anaesth Crit Care Pain Med. 2016;35(6):417-421. doi:10.1016/j.accpm.2016.03.005.
  5. Curr Opin Anaesthesiol. 2013;26(5):613-620. doi:10.1097/ACO.0b013e3283606b71.
  6. Acta Anaesthesiol Scand. 2013;57(5):545-552. doi:10.1111/aas.12071.

 

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