Single-dose lidocaine spinal anesthesia in hip and knee arthroplasty

• Main Authors: Nicholas B. Frisch, MD, MBA, Brian Darrith, BS, Dane C. Hansen, DO, Adrienne Wells, MD, Sheila Sanders, RN, Richard A. Berger, MD
• Format: Article
• Language: English
• Published: Elsevier 2018-06-01
• Series: Arthroplasty Today
• Subjects: Total hip arthroplasty; Total knee arthroplasty; Unicompartmental knee arthroplasty; Anesthesia; Spinal
• Online Access: http://www.sciencedirect.com/science/article/pii/S2352344118300359

Background: With the increasing interest in fast recovery and outpatient joint arthroplasty, short-acting local anesthetic agents and minimal narcotic use are preferred. Lidocaine is a fast-onset, short-duration local anesthetic that has been used for many years in spinal anesthesia. However, lidocaine spinal anesthesia has been reported to have a risk of transient neurologic symptoms (TNSs). The purpose of this study is to determine the safety and efficacy of single-dose lidocaine spinal anesthesia in the setting of outpatient joint arthroplasty. Methods: We performed a prospective study on 50 patients who received lidocaine spinal anesthesia in the setting of outpatient hip and knee arthroplasty. All patients received a single-shot spinal injection, with 2% isobaric lidocaine along with titrated propofol sedation. We evaluated demographic data, length of motor blockage, time to ambulation, time to discharge readiness, patient-reported symptoms of TNS. Results: Of the 50 patients studied, 11 had total hip arthroplasty, 33 total knee arthroplasty, 5 unicompartmental knee arthroplasty, and 1 underwent isolated polyethylene liner exchange in a total knee arthroplasty. The average total duration of motor blockade was 2.89 hours (range 1.73-5.17, standard deviation 0.65). Average time from postanesthesia care unit to return of motor function was 0.58 hours (range 0-1.5, standard deviation 0.48). None of the patients reported TNS. Conclusions: Isobaric lidocaine spinal anesthesia appears to be a safe and effective regimen for outpatient hip and knee arthroplasty. All patients were discharged on the day of surgery with isobaric lidocaine spinal injection. There were no reports of TNSs.