Lidocaine Buys
Dose Response study of Lidocaine 1%
Purpose:
To analyze the sensory and motor block produced by three different volumes of intrathecally lidocaine 1% and thereby determine the appropriate volume to administer for surgery of the lower limbs and perineum.
Methods Forty-eight patients scheduled for perinea or lower limb surgery were randomly assigned to receive 4, 6 or 8 ml lidocaine 1% intrathecally. The wide-spread, duration and regression of analgesia and motor block and side effects were evaluated (by a blinded observer whenever possible).
Results:
The maximum cephalic 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. Individuals 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 milliliters intrathecally lidocaine 1% is adequate for perinea surgery but for lower limb procedures, 6 ml is more appropriate as it consistently provides sensory analgesia above L1 dermatome and complete motor block. 8 ml can effect to an unnecessarily high block with higher incidence of hypotension.
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