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British Journal of Anaesthesia, Vol 82, Issue 4 575-579, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia

CLINICAL INVESTIGATIONS

Transient neurological symptoms after spinal anaesthesia with hyperbaric 5% lidocaine or general anaesthesia

A. Hiller, K. Karjalainen, M. Balk and P. H. Rosenberg
Department of Anaesthesia, Helsinki University Central Hospital, Otolaryngological Hospital, Haartmaninkatu 4E, FIN-00290 Helsinki, Finland; Department of Anaesthesia, Kuusankoski District Hospital, FIN-45750 Sairaalamaki, Finland; Department of Anaesthesia, Paijat-Hame Central Hospital, Keskussairaalankatu 7, FIN-15850 Lahti, Finland; Department of Anaesthesiology, Helsinki University Central Hospital, FIN-00290 Helsinki, Finland

Transient neurotoxicity of concentrated local anaesthetics has been thought to be the main reason for transient neurological symptoms after spinal anaesthesia. Profound musculoligamental relaxation by high doses of local anaesthetics may contribute to the development of postoperative musculoskeletal pain. In order to evaluate the role of the loss of strength of the supportive structures of the spine in the development of transient neurological symptoms, 60 patients (ASA I-II) undergoing minor orthopaedic, varicose vein or inguinal hernia operations were allocated randomly to receive spinal anaesthesia with hyperbaric lidocaine 50 mg ml-1 (85-100 mg) or balanced general anaesthesia with neuromuscular block. Patients were interviewed 24 h later and after 1 week they returned a written questionnaire. Transient neurological symptoms, consisting of pain in the buttocks or pain radiating symmetrically to the lower extremities, occurred in eight patients (27%) receiving spinal anaesthesia and in one patient (3%) receiving general anaesthesia (P < 0.05). We conclude that a transient neurotoxic effect of hyperbaric lidocaine 50 mg ml-1 is probably the main reason for transient neurological symptoms after spinal anaesthesia but musculoligamental relaxation may contribute to the development of low back or leg pain after both anaesthetic techniques.
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