A Study of the Incidence of Transient Neurologic Symptoms and Other Complications Associated with Procaine and Lidocaine Spinal Anesthesia
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Spinal anesthesia is an advantageous operating room procedure that produces anesthesia selective to the surgical site and allows patients to remain alert and aware of their surroundings. Today one of the most frequently used short-acting spinal anesthetics is lidocaine. Recent reports of transient neurologic symptoms (TNS) associated with lidocaine have prompted anesthesiologists to examine its effectiveness and to re-examine the anesthetic effects of procaine, the agent that lidocaine supplanted thirty-five years ago. The investigation was a twofold comparison: first, of the incidence of TNS after spinal anesthesia with procaine and lidocaine, and second, of the two anesthetics as to the duration of sensory anesthesia, micturition time (the time to ability to urinate), and the incidence of nausea. A double-blinded study was conducted on those patients that would be having a spinal block anticipated to last <= 90 minutes. Each of the patients was randomized to receive one of the two local anesthetics, and then intraoperative data was collected. In the recovery room the patients were monitored, and their sensory level and time to ability to urinate were determined. On the third postoperative day a blinded investigator telephoned the patients to see if there was any presence of back and/or leg pain. Results from this study found no incidence of TNS associated with procaine and a moderate amount associated with lidocaine. Results also displayed a higher incidence of nausea associated with procaine. Additionally, it took a slightly longer time to reach a sensory level of S1 and time to be able to urinate with procaine. However, despite its shortcomings, it was established that procaine would be a useful alternative to lidocaine as a short-acting anesthetic.