Selective spinal anesthesia for outpatient laparoscopy. II: Epinephrine and spinal cord function

Purpose: To compare two small-dose solutions (with and without: epinephrine) for spinal anesthesia during outpatient laparoscopy and to determine spinal cord function with these low-dose solutions. Method: Twenty outpatients undergoing gynecological laparoscopy were randomly assigned to receive spinal anesthesia with one of two low dose solutions. Group LS- 10 mg lidocaine plus 10 mug sufentanil; Group LSE- 10 mg lidocaine plus 10 mug sufentanil plus epinephrine 50 mug. Solutions were diluted to three millilitres with sterile water for injection. A 27-gauge Whitacre needle was inserted at L2-3 or L3-4 in the sitting position. Operating conditions and spinal cord function (spinothalamic, dorsal column and motor) were assessed. Results: Operating conditions were good - excellent in both groups. The incidence of shoulder tip discomfort, pruritus and nausea, and the amount of supplementation with alfentanil and midazolam was not different between groups. Most patients in both groups had preserved dorsal column function and normal motor power on arrival in PACU and were able to satisfy 'walk out' criteria. Recovery of pinprick sensation and discharge times were not different. Mild pruritus (VAS score less than or equal to 5)was present in both groups. Conclusion: For short duration laparoscopy, addition of 50 mug epinephrine to a small dose of spinal 10 mg lidocaine with 10 mug sufentanil did not provide additional benefit in terms of intraoperative analgesia or operating conditions. Spinal cord function was preserved with small-dose techniques.