Selective spinal anesthesia for outpatient laparoscopy. I: Characteristics of three hypobaric solutions

Purpose: To determine the characteristics and recovery profiles of three hypobaric spinal anesthetic solutions. Methods: Thirty outpatients undergoing outpatient laparoscopy were randomly assigned to receive spinal anesthesia with one of three small-dose solutions. Group I - 20 mg lidocaine plus 25 mug fentanyl; Group II - 20 mg lidocaine plus 10 mug sufentanil; Group III - 10 mg lidocaine plus 10 mug sufentanil. Solutions were diluted to three ml with sterile water for injection, A 27-gauge Whitacre needle was inserted at L2-3 or L3-4 in the sitting position. Sensory and motor recovery were assessed with pinprick. proprioception, light touch and a modified Bromage scale. Results: Operating conditions were good to excellent in all three groups. The incidence of shoulder tip discomfort, pruritus and nausea was not significantly different between groups. Light touch was present in all three groups and proprioception was present in most patients during and after surgery. Group III patients had a more rapid recovery of pinprick analgesia and Group II patients had the slowest recovery of pinprick analgesia, Motor block recovery was comparable in the three groups. Eighty percent of patients in Groups III and I were able to perform 'deep knee bends' and 'straight leg raises' at the end of surgery. Conclusion: For short duration laparoscopy, spinal 10 mg lidocaine with 10 mug sufentanil provided selective pin prick analgesia, with preserved touch, proprioception and limited motor block. Operating conditions were satisfactory and most patients were able to fulfill 'walk out' criteria at the end of surgery.