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Regional Anaesthesia:
M. P. Hendriks, C. J. M. de Weert, M. M. J. Snoeck, H. P. Hu, M. A. L. Pluim, and M. J. M. Gielen
Plain articaine or prilocaine for spinal anaesthesia in day-case knee arthroscopy: a double-blind randomized trial
Br. J. Anaesth. 2009; 102: 259-263 [Abstract] [Full text] [PDF]
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[Read E-letter] Some remarks and questions on the use of articaïne or prilocaïne
Chris van Velzen, Ronald L. Luitwieler; Serge J.C. Verbrugge   (1 April 2009)

Some remarks and questions on the use of articaïne or prilocaïne 1 April 2009
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Chris van Velzen ,
Ronald L. Luitwieler; Serge J.C. Verbrugge

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Re: Some remarks and questions on the use of articaïne or prilocaïne

Dear Editor,

With interest we read the article of Hendriks et al. We have performed a similar study for evaluation within our own institution in 1998 (unpublished data, n = 32). In our study we compared lidocaïne 2% plain 80 mg with articaïne 5% heavy 100 mg for spinal anaesthesia for knee arthroscopy and inguinal herniotomy in day care. In contrast to the results of the study by Hendriks et al., we found a significant difference in block height. For pinprick/warm-cold discrimination Th10(range L3/Th3) versus Th6 (range Th10/Th4) lidocaïne versus articaïne (p = 0.002 and p = 0.007). This led us to advise not to use lidocaïne for inguinal herniotomy due to the unpredictable level of blockade. The duration to full recovery of motor function was 133(range 75/180) versus 123 (range 90/180) minutes lidocaïne versus articaïne (not significant) which is not very different from the recovery from articaïne reported by Hendriks et al. In the recovery room, in the group given articaïne 5 persons had incontinence for urine versus 1 person in the lidocain group (p = 0.038). This led us to change the dosage for spinal articaïne in 1 mg per kilogram bodyweight with a maximum of 80 mg for day care surgery. Our questions are: Do the authors agree with our suggestion not to use lidocaïn for procedures in the groin such as inguinal herniotomy(and as consequence use articaïne for these kind of procedures in day care surgery). And do the authors think that the dose of 100 mg articaïne we used led to the problem of incontinence (we did not have a bladder scan in those days) and agree with us that the dosage should be lower (as they have used in their study).

Sincerly,

C van Velzen, R.L. Luitwieler, S.J.C. Verbrugge, Anesthesiologists St Fransciscus Gasthuis, Rotterdam, The Netherlands

Conflict of Interest:

None declared