Transient neurologic symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics

Dusanka DZ Zaric; Christian CC Christiansen; Nathan Leon Pace; Yodying Punjasawadwong

doi:10.1002/14651858.CD003006.pub2

Síntomas neurológicos transitorios (SNT) después de la anestesia espinal con lidocaína versus otros anestésicos locales

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Referencias

Referencias de los estudios incluidos en esta revisión

Ir a:

estudios excluidos
otras referencias

Aouad MT, Siddik SS, Jalbout MI, Baraka AS. Does pregnancy protect against intrathecal lidocaine‐induced transient neurological symptoms?. Anesthesia and Analgesia 2001;92(2):401‐4. [MEDLINE: 11159240]

Breebaart MB, Vercauteren MP, Hoffmann VL, Adriaensen HA. Urinary bladder scanning after day‐case arthroscopy under spinal anaesthesia: comparison between lidocaine, ropivacaine and levobupivacaine. British Journal of Anaesthesia 2003;90(3):309‐13. [MEDLINE: PMID: 12594142]

de Weert K, Traksel M, Gielen M, Slappendel R, Weber E, Dirksen R. The incidence of transient neurological symptoms after spinal anaesthesia with lidocaine compared to prilocaine. Anaesthesia 2000;55(10):1020‐4. [MEDLINE: 11012500]

Hampl KF, Schneider MC, Thorin D, Ummenhofer W, Drewe J. Hyperosmolarity does not contribute to transient radicular irritation after spinal anesthesia with hyperbaric 5% lidocaine. Regional Anesthesia 1995;20(5):363‐8. [MEDLINE: 8519711]

Hampl KF, Heinzmann‐Wiedmer S, Luginbuehl MC, Drasner K. Transient neurologic symptoms after spinal anesthesia. Anesthesiology 1998;88(3):629‐33. [MEDLINE: 952380]

Hodgson PS, Liu SS, Barta MS, Gras TW, Pollock J, Neal JM. Procaine compared with lidocaine for incidence of transient neurologic symptoms. Regional Anesthesia and Pain Medicine 2000;25(3):218‐22. [MEDLINE: 10834773]

Keld KD, Hein L, Dalgaard M, Krogh L, Rodt SÅ. The incidence of transient neurologic symptoms (TNS) after spinal anaesthesia in patients undergoing surgery in the supine position. Hyperbaric lidocaine 5% versus hyperbaric bupivacaine 0,5%. Acta Anaesthesiologica Scandinavica 2000;44(3):285‐90. [MEDLINE: 10714841]

Le Truong HH, Girard M, Drolet P, Grenier Y, Boucher C, Bergeron L. Spinal anesthesia: a comparison of procaine and lidocaine. Canadian Journal of Anaesthesia 2001;48(5):470‐3. [MEDLINE: 11394516]

Liguori GA, Zayas VM, Chisholm MF. Transient neurologic symptoms after spinal anesthesia with mepivacaine and lidocaine. Anesthesiology 1998;88(3):619‐23. [MEDLINE: 9523803]

Martinez‐Bourio M, Arzuaga M, Quintana JM, Aguilera L, Aguirre J, Saez‐Equilaz JL, et al. Incidence of transient neurologic symptoms after hyperbaric subarachnoid anesthesia with 5% lidocaine and 5% prilocaine. Anesthesiology 1998;88(3):624‐8. [MEDLINE: 9523804]

Philip J, Sharma SK, Gottumukkala VNR, Perez BJ, Slaymaker EA, Wiley J. Transient neurologic symptoms after spinal anesthesia with lidocaine in obstetric patients. Anesthesia and Analgesia 2001;92(2):405‐9. [MEDLINE: 11159241]

Pollock J, Neal JM, Stephensen CA, Wiley CE. Prospective study of the incidence of transient radicular irritation in patients undergoing spinal anesthesia. Anesthesiology 1996;84(6):1361‐7. [MEDLINE: 8669677]

Salazar F, Bogdanovich A, Adalia R, Chabas E, Gomar C. Transient neurologic symptoms after spinal anaesthesia using isobaric 2% mepivacaine and isobaric 2% lidocaine. Acta Anaesthesiologica Scandinavica 2001;45(2):240‐5. [MEDLINE: 11731731]

Salmela L, Aromaa U. Transient radicular irritation after spinal anesthesia induced with hyperbaric solutions of cerebrospinal fluid‐diluted lidocaine 50 mg/ml or mepivacaine 40 mg/ml or bupivacaine 5 mg/Ml. Acta Anaesthesiologica Scandinavica 1998;42(7):765‐9. [MEDLINE: 9698950]

Østgaard G, Hallaråker O, Ulveseth OK, Flaatten H. A randomised study of lidocaine and prilocaine for spinal anaesthesia. Acta Anaesthesiologica Scandinavica 2000;44(4):436‐40. [MEDLINE: 10757577]

Referencias de los estudios excluidos de esta revisión

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estudios incluidos
otras referencias

Ben‐David B, Maryanovsky M, Gurevitch A, Lucyk C, Solosko D, Frankel R, et al. A comparison of minidose lidocaine‐fentanyl and conventional‐dose lidocaine spinal anesthesia. Anesthesia and Analgesia 2000;91(4):865‐70. [MEDLINE: PMID: 11004039]

Bergeron L, Girard M, Drolet P, Grenier Y, Truong HHL, Boucher C. Spinal procaine with and without epinephrine and its relation to transient radicular irritation. Canadian Journal of Anaesthesia 1999;46(9):846‐9. [MEDLINE: PMID: 10490152]

Chan VW, Garcia J, Al‐Kaisy A, Drasner K. A comparative study of low‐dose hyperbaric spinal lidocaine 0,5% versus 5% for continuous spinal anesthesia. Regional Anesthesia and Pain Medicine 1998;23(2):164‐9. [MEDLINE: PMID: 9570605]

Frey K, Holman S, Mikat‐Stevens M, Vazquez J, White L, Pedicini E, et al. The recovery profile of hyperbaric spinal anesthesia with lidocaine, tetracaine and bupivacaine. Regional Anesthesia and Pain Medicine 1998;23(2):159‐63. [MEDLINE: PMID: 9570604]

Gentili M, Senlis H, Houssel P, Monnier B, Bonnet F. Single‐shot spinal anesthesia with small doses of bupivacaine. Regional Anesthesia 1997;22(6):511‐4. [MEDLINE: PMID: 9425965]

Hampl KF, Schneider MC, Ummenhofer W, Drewe J. Transient neurological symptoms after spinal anesthesia. Anesthesia and Analgesia 1995;81(6):1148‐53. [MEDLINE: PMID: 7486096]

Hampl KF, Schneider MC, Pargger H, Gut J, Drewe J, Drasner K. A similar incidence of transient neurologic symptoms after spinal anesthesia with 2% and 5% lidocaine. Anesthesia and Analgesia 1996;83(5):1051‐4. [MEDLINE: PMID: 8895284]

Henderson DJ, Faccenda KA, Morrison LM. Transient radicular irritation with intrathecal plain lignocaine. Acta Anaesthesiologica Scandinavica 1998;42(3):376‐8. [MEDLINE: PMID: 9542568]

Hiller A, Karjalainen K, Balk M, Rosenberg PH. Transient neurological symptoms after spinal anaesthesia with hyperbaric 5% lidocaine or general anaesthesia. British Journal of Anaesthesia 1999;82(4):575‐9. [MEDLINE: PMID: 10472226]

Liam BL, Yim CF, Chong JL. Dose response study of lidocaine 1% for spinal anaesthesia for lower limb and perineal surgery. Canadian Journal of Anaesthesia 1998;45(7):645‐50. [MEDLINE: PMID: 9717596]

Loo CC, Irestedt L. Cauda equina syndrome after spinal anaesthesia with hyperbaric 5% lignocaine: a review of six cases of cauda equina syndrome reported to the Swedish Pharmaceutical Insurance 1993‐1997. Acta Anaesthesiologica Scandinavica 1999;43(4):371‐9. [MEDLINE: PMID: 10225068]

Markey JR, Montiague R, Winnie AP. A comparative efficacy study of hyperbaric 5% lidocaine and 1,5% lidocaine for spinal anesthesia. Anesthesia and Analgesia 1997;85(5):1105‐7. [MEDLINE: PMID: 9356108]

Morisaki H, Masuda J, Kaneko S, Matsushima M, Takeda J. Transient neurologic syndrome in one thousand forty‐five patients after 3% lidocaine spinal anesthesia. Anesthesia and Analgesia 1998;86(5):1023‐6. [MEDLINE: PMID: 9585290]

Murto K, Lui AC, Cicutti N. Adding low dose meperidine to spinal lidocaine prolongs postoperative analgesia. Canadian Journal of Anaesthesia 1999;46(4):327‐34. [MEDLINE: PMID: 10232715]

Pawlowski J, Sukhani R, Pappas AL, Kim KM, Lurie J, Gunnerson H, et al. The anesthetic and recovery profile of two doses (60 and 80 mg) of plain mepivacaine for ambulatory spinal anesthesia. Anesthesia and Analgesia 2000;91(3):580‐4. [MEDLINE: PMID: 10960380]

Pollock JE, Liu SS, Neal JM, Stephenson CA. Dilution of spinal lidocaine does not alter the incidence of transient neurologic symptoms. Anesthesiology 1999;90(2):445‐50. [MEDLINE: PMID: 9952151]

Salmela L, Aromaa U, Cozanitis DA. Leg and back pain after spinal anaesthesia involving hyperbaric 5% lignocaine. Anaesthesia 1996;51(4):391‐3. [MEDLINE: PMID: 8686832]

Sia S, Pullano C. Transient radicular irritation after spinal anaesthesia with 2% isobaric mepivacaine. British Journal of Anaesthesia 1998;81(4):622‐4. [MEDLINE: PMID: 9924248]

Tong D, Wong J, Chung F, Friedlander M, Bremang J, Mezei G, et al. Prospective study on incidence and functional impact of transient neurologic symptoms associated with 1% versus 5% hyperbaric lidocaine in short urologic procedures. Anesthesiology 2003;98(2):485‐94. [MEDLINE: PMID: 12552209]

Wong CA, Slavenas P. The incidence of transient radicular irritation after spinal anesthesia in obstetric patients. Regional Anesthesia and Pain Medicine 1999;24(1):55‐8. [MEDLINE: PMID: 9952096]

Zayas VM, Liguori GA, Chisholm MF, Susman MH, Gordon MA. Dose response relationships for isobaric spinal mepivacaine using the combined spinal epidural technique. Anesthesia and Analgesia 1999;89(5):1167‐71. [MEDLINE: PMID: 10553828]

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Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

estudios excluidos

Aouad 2001

Methods	Randomization: yes Patient blinding: yes. Provider blinding: no. Assessor blinding: yes. Dropouts: none.
Participants	Country: Lebanon. ASA: I, II. Gender: female. Ages: 31 ± 5. Caesarean section. Surgical positioning: supine. Study patients: 200.
Interventions	Drug 1: 5% lido, hyperbaric, fixed dose (1.5ml). Drug 2: 0.75% bupi, hyperbaric, fixed dose (1.6ml). Needle: 25 G, pencil‐point.
Outcomes	TNS at 1 day. Back pain
Notes	Follow‐up duration : 1.3 days. Follow‐up method: phone contact.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Breebaart 2003

Methods	Randomization: yes Patient blinding: yes. Provider blinding: yes. Assessor blinding: unclear. Dropouts: none.
Participants	Country: Belgium ASA: I gender: male and female. Ages: 42 (20‐57), 39 (18‐59), 39 (19‐57) Ambulatory surgery Surgical positioning: supine. Study patients: 90
Interventions	Drug 1: 2% lido, isobaric, fixed dose (3ml). Drug 2: 0.5% levo, isobaric, fixed dose (3ml), Drug 3: 0.75% ropi, isobaric, fixed dose (3ml). Needle: 27 G, pencil‐point.
Outcomes	TNS at 2 day. Urinary retention.
Notes	Follow‐up duration: 2 days. Follow‐up method: phone contact. TNS therapy: none. TNS resolution: 1 day.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

de Weert 2000

Methods	Randomization: yes. Patient blinding: yes. Provider blinding: unclear. Assessor blinding: unclear. Dropouts: 1 outcome reported.
Participants	Country: the Netherlands. ASA: I, II. Gender: male, female. Ages: 43 ± 14, 37 ± 11. Ambulatory surgery: unclear. Surgical positioning: supine. Study patients: 70.
Interventions	Drug 1: 2% lido, isobaric, fixed dose (4 ml). Drug 2: 2% prilo, isobaric, fixed dose (4 ml). Needle: 25 G, pencil‐point.
Outcomes	TNS at 1 day.
Notes	Follow‐up duration: 1‐4 days. Follow‐up method: direct contact, phone contact. TNS therapy: unclear. TNS resolution: 2‐3 days.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Hampl 1995b

Methods	Randomization: yes. Patient blinding: yes. Provider blinding: yes. Assessor blinding: yes. Dropouts: 1 outcome not reported.
Participants	Country : Switzerland. ASA: I, II. Gender: female. Ages: 19‐81. Procedures: gynaecologic. Ambulatory surgery: no. Surgical positioning: lithotomy. Study patients: 44.
Interventions	Drug 1: 5% lido, hyperbaric, fixed dose (1.5 ml). Drug 2: 0.5% bupi, hyperbaric, fixed dose (1.5 ml). Needle: 25 G, pencil‐point.
Outcomes	TNS at 1 day. Back pain.
Notes	Follow‐up duration: 1‐4 days. Follow‐up method: direct contact. TNS therapy: unclear. TNS resolution: all recovered.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Hampl 1998

Methods	Randomization: yes. Patient blinding: yes. Provider blinding: yes. Assessor blinding: yes. Dropouts: none.
Participants	Country: Switzerland. ASA: I, II. Gender: female. Ages: 39 ± 17; 39 ± 13; 36 ± 14. Procedures: gynaecologic. Ambulatory surgery: unclear. Surgical positioning: lithotomy. Study patients: 90.
Interventions	Drug 1: 2% lido, hyperbaric, fixed dose (2.5 ml). Drug 2: 2% prilo, hyperbaric, fixed dose (2.5 ml). Drug 3: 0.5% bupi, hyperbaric, fixed dose (2.5 ml). Needle: 25 G, pencil‐point.
Outcomes	TNS at 1 day.
Notes	Follow‐up duration: 1‐5 days. Follow‐up methods: direct contact. TNS therapy: unclear. TNS resolution: 2‐4 days.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Hodgson 2000

Methods	Randomization: yes. Patient blinding: yes. Provider blinding: no. Assessor blinding: yes. Dropouts: none.
Participants	Country: USA. ASA: I, II. Gender: male, female. Ages: 49 ± 12, 49 ± 12. Procedures: arthroscopy. Ambulatory surgery: yes. Surgical positioning: supine. Study patients: 70.
Interventions	Drug 1: 5% lido, hyperbaric, fixed dose (1 ml). Drug 2: 5% pro, hyperbaric, fixed dose (2 ml). Needle: 24 & 25 G, pencil‐point.
Outcomes	TNS at 1 day.
Notes	Follow‐up duration: 3 days. Follow‐up method: phone contact. TNS therapy: unclear. TNS resolution: 48 hours.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Keld 2000

Methods	Randomization: yes. Patient blinding: yes. Provider blinding: no. Assessor blinding: yes. Dropouts: 1 outcome reported.
Participants	Country: Denmark. ASA: I, II. Gender: male, female. Ages: 43 ± NA, 46 ± NA. Procedures: ortho, general surgery. Ambulatory surgery: unclear. Surgical positioning: supine. Study patients: 70.
Interventions	Drug 1: 5% lido, hyperbaric, fixed dose (2 ml). Drug 2: 0.5% bupi, hyperbaric, fixed dose (2.5 ml). Needle: 25 G, pencil‐point.
Outcomes	TNS at 1 day. Back pain.
Notes	Follow‐up duration 1‐3 days. Follow‐up methods: phone contact. TNS therapy: unclear. TNS resolution: 41 hours.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Le Truong 2001

Methods	Randomization: yes. Patient blinding: yes. Provider blinding: no. Assessor blinding: yes. Dropouts: 6 outcomes not reported.
Participants	Country: Canada. ASA: I, II. Gender: male, female. Ages: 38 ± 9, 41 ± 11. Procedures: general surgery, gynaecologic. Ambulatory surgery: unclear. Surgical positioning: supine, lithotomy. Study patients: 66.
Interventions	Drug 1: 5% lido, hyperbaric, fixed dose (2 ml). Drug 2: 10% pro, baricity unclear, fixed dose (1 ml). Needle: 27 G, pencil point.
Outcomes	TNS at 2 days.
Notes	Follow‐up duration: 2 days. Follow‐up method: unclear. TNS therapy: unclear. TNS resolution: unclear.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Liguori 1998

Methods	Randomization: yes. Patient blinding: yes. Provider blinding: no. Assessor blinding: yes. Dropouts: 3 outcomes not reported.
Participants	Country: USA. ASA: I, II, III. Gender: male, female. Ages: 18 ± 12; 42 ± 10. Procedures: arthroscopy. Ambulatory surgery: yes. Surgical positioning: supine. Study patients: 60.
Interventions	Drug 1: 2% lido, baricity unclear, fixed dose (3 ml). Drug 2: 1.5% mepi, baricity unclear, fixed dose (3 ml). Needle: 27 G, pencil‐point.
Outcomes	TNS at 1‐2 days.
Notes	Follow‐up duration: 2‐5 days. Follow‐up method: phone contact. TNS therapy: NSAIDs. TNS resolution: duration 1‐5 days.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Martinez‐Bourio 1998

Methods	Randomization: yes. Patient blinding: yes. Provider blinding: no. Assessor blinding: yes. Dropouts: 2 outcomes reported.
Participants	Country: Spain. ASA: I, II, III. Gender: male, female. Ages: 18‐80. Procedures: ortho, urologic, gynaecologic, vascular, general surgery. Ambulatory surgery: unclear. Surgical positioning: supine, prone, lithotomy. Study patients: 200.
Interventions	Drug 1: 5% lido, hyperbaric, variable dose. Drug 2: 5% prilo, hyperbaric, variable dose. Needle: 25 G, pencil‐point.
Outcomes	TNS at 1‐2 days. Back pain.
Notes	Follow‐up duration: 3‐5 days. Follow‐up method: direct contact, phone contact. TNS therapy: NSAIDs. TNS resolution: maximum duration 10 days.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Philip 2001

Methods	Randomization: yes. Patient blinding: yes. Provider blinding: yes. Assessor blinding: yes. Dropouts: 1 outcome reported.
Participants	Country: USA ASA: I. Gender: female. Ages: 27 ± 5; 25 ± 4. Procedures: postpartum tubal ligation. Ambulatory surgery: no. Surgical positioning: supine. Study patients: 58.
Interventions	Drug 1: 5% lido, hyperbaric, variable dose. Drug 2: 0.75% bupi, hyperbaric, variable dose. Needle: 25 G, pencil‐point.
Outcomes	TNS at 1 day. Back pain.
Notes	Follow‐up duration: 3 weeks. Follow‐up method: direct contact. TNS therapy: unclear. TNS resolution: complete recovery at 2 days.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Pollock 1996

Methods	Randomization: yes. Patient blinding: yes. Provider blinding: yes. Assessor blinding: yes. Dropouts: 7 outcomes reported.
Participants	Country: USA. ASA: I, II. Gender: male, female. Ages: 59 ± 17; 53 ± 12; 62 ± 14; 51 ± 13; 52 ± 16; 50 ± 16. Procedures: arthroscopy, herniorrhaphy. Ambulatory surgery: yes. Surgical positioning: supine. Study patients: 159.
Interventions	Drug 1: 2%, 5% lido; hyperbaric, isobaric; fixed dose (1.2, 3.0, 1.5, 3.75 ml). Drug 2: 0.75% bupi, hyperbaric, fixed dose (1.0, 1.2 ml). Needle: 22 & 25 G, cutting & pencil‐point.
Outcomes	TNS at 3 days. Back pain.
Notes	Follow‐up duration: 3‐14 days. Follow‐up method: phone contact. TNS therapy: NSAIDs, opioids. TNS resolution: no symptoms at 14 days.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Salazar 2001

Methods	Randomization: yes. Patient blinding: unclear. Provider blinding: no. Assessor blinding: yes. Dropouts: 1 outcome not reported.
Participants	Country: Spain. ASA: I, II. Gender: male, female. Ages: 48 ± 16; 42 ± 16. Procedures: ortho. Ambulatory surgery: no. Surgical positioning: supine. Study patients: 81.
Interventions	Drug 1: 2% lido, isobaric, variable dose. Drug 2: 2% mepi, isobaric, variable dose. Needle: 26 & 27 G, cutting.
Outcomes	TNS at 1 day.
Notes	Follow‐up duration: 1+ days. Follow‐up method: direct contact. TNS therapy: NSAIDs. TNS resolution: 1 day.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Salmela 1998

Methods	Randomization: yes. Patient blinding: no. Provider blinding: no. Assessor blinding: yes. Dropouts: none.
Participants	Country: Finland ASA: I, II, III, IV. Gender: male, female. Ages: 29‐91. Procedures: urologic. Ambulatory surgery: unclear. Surgical positioning: supine, lithotomy. Study patients: 90.
Interventions	Drug 1: 5% lido, hyperbaric, variable dose. Drug 2: 0.5% bupi, hyperbaric, variable dose. Drug 3: 4% mepi, hyperbaric, variable dose. Needle: 25 & 27 G, cutting & pencil‐point.
Outcomes	TNS at 1 day.
Notes	Follow‐up duration: 1 day. Follow‐up method: direct contact. TNS therapy: NSAIDs, opioids. TNS resolution: 1‐2 days.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Østgaard 2000

Methods	Randomization: yes. Patient blinding: yes. Provider blinding: unclear. Assessor blinding: yes. Dropouts: 1 outcome not reported.
Participants	Country: Norway ASA: unclear. Gender: male, female. Ages: 65 ± 17; 69 ± 12. Procedures: urologic. Ambulatory surgery: unclear. Surgical positioning: supine, lithotomy. Study patients: 100.
Interventions	Drug 1: 2% lido, isobaric, fixed dose (4 ml). Drug 2: 2% prilo, isobaric, fixed dose (4 ml). Needle: 25 & 26 & 27 & 29 G, cutting.
Outcomes	TNS at 1 day. Other pain.
Notes	Follow‐up duration: 1 day. Follow‐up method: direct contact. TNS therapy: unclear. TNS resolution: unclear.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

ASA: American Society of Anesthesiologist Physical Status Score (I, II, III, IV).
bupi: bupivacaine; levo: levobupivacaine; lido: lidocaine; mepi: mepivacaine; prilo: prilocaine; pro: procaine; ropi: ropivacaine.
NA: not available.
TNS: Transient Neurologic Symptoms.

Characteristics of excluded studies [ordered by study ID]

Ir a:

estudios incluidos

Study	Reason for exclusion
Ben‐David 2000	Fentanyl was used together with lidocaine. No arm with another local anaesthetic.
Bergeron 1999	No lidocaine, only one arm with procaine Incidence of TNS: 1 of 62 patients, but high incidence of nausea.
Chan 1998	Continuous spinal anaesthesia with lidocaine 5% . No follow‐up, no mention of TNS
Frey 1998	Volunteers ‐ no surgery ‐ excluded. N = 12. Cross over: lidocaine 5% (100 mg), tetracaine 1% (30 mg) and bupivacaine 0.75% (15 mg). 3 of 12 subjects had TNS ‐ it was quite unpleasant ‐ unable to sit and needed NSAID
Gentili 1997	No lidocaine. Bupivacaine 0.1%, 0.15% and 0.2%. Volume: 4 ml. N = 90, there were no cases of TNS.
Hampl 1995a	Nonrandomized study
Hampl 1996	Only lidocaine in two different concentrations: 5% vs. 2%. No difference in the incidence of TNS (8 of 25 vs. 10 of 25 with 2% lidocaine). Reduction in concentration did not reduce the risk of TNS.
Henderson 1998	Case history: one patient with TNS after 1% Lidocaine 40 mg. Full recovery.
Hiller 1999	Only one arm with lidocaine: second arm with general anaesthesia. Even patients who receive only general anaesthesia can develop TNS.
Liam 1998	Only lidocaine: three arms with 1% lidocaine in different volumes: 4, 6 and 8 ml ‐ no cases of TNS.
Loo 1999	Swedish Pharmacological Insurance reported six cases of cauda equina syndrome between 1993‐1997. Five cases after single spinal injection of lidocaine 5% and one case after repeated injection. Lidocaine doses was 60‐100 mg. All cases sustained permanent neurological deficits. Recommendation: use plain 2% lidocaine and no more than 60 mg.
Markey 1997	1.5% lidocaine is as effective as 5% for patients undergoing hernia operation. No mention of TNS.
Morisaki 1998	Nonrandomized study : 4 of 1045 patients that received lidocaine 3% 45 mg (for anorectal surgery) had TNS.
Murto 1999	Intrathecal meperidine 0.3 mg/kg was added to lidocaine to prolong postoperative analgesia. No mention of TNS.
Pawlowski 2000	No lidocaine. Mepivacaine 1.5% (60 mg) and 2% (80 mg) was used in 60 patients. Follow‐up 24 h: no cases of TNS.
Pollock 1999	Only lidocaine was used: three arms with 0.5%, 1% and 2% lidocaine: incidence of TNS was not concentration‐dependant (20 out of 109 patients).
Salmela 1996	Only one arm with Lidocaine 5%. 13 out of 44 urological patients had signs of TNS.
Sia 1998	3 cases of TNS after spinal mepivacaine.
Tong 2003	Only lidocaine was used: two arms with 80 mg lidocaine: 1% (N = 218) and 5 % hyperbaric lidocaine (N = 235): incidence of TNS was not concentration‐dependant (21% vs. 18%).
Wong 1999	Nonrandomized study
Zayas 1999	No lidocaine. Dose‐response study for spinal mepivacaine 1.5%. N =25. 40, 45 and 60 mg. 5 cases of TNS out of 75 ptt. ‐ irrespective of Mepivacaine doses.

N ‐ numbers
PTT ‐ patients
TNS ‐Transient neurologic symptoms
Vs ‐ versus

Data and analyses

Open in table viewer

Comparison 1. Lidocane versus other local anaesthetic

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Transient Neurologic Symptoms Show forest plot	15	1437	Risk Ratio (M‐H, Random, 95% CI)	4.47 [2.17, 9.20]
Open in figure viewer Analysis 1.1 Comparison 1 Lidocane versus other local anaesthetic, Outcome 1 Transient Neurologic Symptoms.
1.1 Bupivacaine	7	621	Risk Ratio (M‐H, Random, 95% CI)	6.65 [2.05, 21.56]
1.2 Mepivacaine	3	182	Risk Ratio (M‐H, Random, 95% CI)	1.05 [0.15, 7.45]
1.3 Prilocaine	4	414	Risk Ratio (M‐H, Random, 95% CI)	5.62 [2.07, 15.23]
1.4 Procaine	2	130	Risk Ratio (M‐H, Random, 95% CI)	6.94 [1.94, 24.86]
1.5 Ropivacaine	1	45	Risk Ratio (M‐H, Random, 95% CI)	5.81 [0.25, 134.73]
1.6 Levobupivacine	1	45	Risk Ratio (M‐H, Random, 95% CI)	9.69 [0.49, 189.93]

Open in table viewer

Comparison 2. Lidocaine versus other local anaesthetic (excluding mepivacaine)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Transient Neurologic Symptoms Show forest plot	13	1255	Risk Ratio (M‐H, Fixed, 95% CI)	7.16 [4.02, 12.75]
Open in figure viewer Analysis 2.1 Comparison 2 Lidocaine versus other local anaesthetic (excluding mepivacaine), Outcome 1 Transient Neurologic Symptoms.
1.1 Bupivacaine	7	621	Risk Ratio (M‐H, Fixed, 95% CI)	7.60 [3.00, 19.30]
1.2 Prilocaine	4	414	Risk Ratio (M‐H, Fixed, 95% CI)	6.14 [2.31, 16.32]
1.3 Procaine	2	130	Risk Ratio (M‐H, Fixed, 95% CI)	7.8 [2.19, 27.77]
1.4 Ropivacaine	1	45	Risk Ratio (M‐H, Fixed, 95% CI)	5.81 [0.25, 134.73]
1.5 Levobupivacaine	1	45	Risk Ratio (M‐H, Fixed, 95% CI)	9.69 [0.49, 189.93]

Analysis 1.1

Comparison 1 Lidocane versus other local anaesthetic, Outcome 1 Transient Neurologic Symptoms.

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Analysis 2.1

Comparison 2 Lidocaine versus other local anaesthetic (excluding mepivacaine), Outcome 1 Transient Neurologic Symptoms.

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Table 1. Patients who developed TNS after intrathecal lidocaine

Study ID	TNS #/N (%)	Pain score (0‐10)	TNS duration	Therapy
Aouad 2001	0 (0)
de Weert 2000	7/35 (20)	Day 1 mean VPS = 5.3 (range 2‐8)	Maximum duration 3 days	Not described
Hampl 1995b	9/28 (32)	Not tallied	Maximum duration 4 days	Not described
Hampl 1998	9/30 (30)	Mean maximum VAS = 3.75	Maximum duration 2 days	Not described
Hodgson 2000	11/35 (31)	Mean VPS = 5	Mean duration 2 days	Not described
Keld 2000	9/35 (26)	Mean VPS = 3.5 (range 2‐8)	Maximum duration 4 days	Not described
Liguori 1998	6/27 (22)	Not tallied	Maximum duration 5 days	NSAIDs
Le Truong	8/30 (27)	Not tallied	Unspecified	Not described
Martinez‐Bourio 1998	4/98 (4)	Not tallied	Maximum duration 10 days	NSAIDs
Østgaard 2000	7/49 (14)	VPS range 5‐9.5	Maximum duration 3 days	Not described
Philip 2001	1/30 (3)	Maximum VAS = 3	Maximum duration 2 days	Not described
Pollock 1996	16/107 (15)	Mean VPS = 6.2 (range 1‐9)	Maximum duration 4 days	NSAIDs and opioids
Salazar 2001	1/40 (3)	Maximum VAS = 9‐10	Maximum duration 1 day	NSAIDs
Salmela 1998	6/30 (20)	Moderate pain	Maximum duration 1 day	NSAIDs and opioids
Breebaart 2003	3/30 (10)	Not tallied	1 day	Not described

Key to abbreviations:	VPS: Verbal Pain Scale	VAS: Visual Analogue Scale

Table 1. Patients who developed TNS after intrathecal lidocaine

Ir a la tabla de la revisión

Comparison 1. Lidocane versus other local anaesthetic

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Transient Neurologic Symptoms Show forest plot	15	1437	Risk Ratio (M‐H, Random, 95% CI)	4.47 [2.17, 9.20]

1.1 Bupivacaine	7	621	Risk Ratio (M‐H, Random, 95% CI)	6.65 [2.05, 21.56]
1.2 Mepivacaine	3	182	Risk Ratio (M‐H, Random, 95% CI)	1.05 [0.15, 7.45]
1.3 Prilocaine	4	414	Risk Ratio (M‐H, Random, 95% CI)	5.62 [2.07, 15.23]
1.4 Procaine	2	130	Risk Ratio (M‐H, Random, 95% CI)	6.94 [1.94, 24.86]
1.5 Ropivacaine	1	45	Risk Ratio (M‐H, Random, 95% CI)	5.81 [0.25, 134.73]
1.6 Levobupivacine	1	45	Risk Ratio (M‐H, Random, 95% CI)	9.69 [0.49, 189.93]

Comparison 1. Lidocane versus other local anaesthetic

Ir a la tabla de la revisión

Comparison 2. Lidocaine versus other local anaesthetic (excluding mepivacaine)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Transient Neurologic Symptoms Show forest plot	13	1255	Risk Ratio (M‐H, Fixed, 95% CI)	7.16 [4.02, 12.75]

1.1 Bupivacaine	7	621	Risk Ratio (M‐H, Fixed, 95% CI)	7.60 [3.00, 19.30]
1.2 Prilocaine	4	414	Risk Ratio (M‐H, Fixed, 95% CI)	6.14 [2.31, 16.32]
1.3 Procaine	2	130	Risk Ratio (M‐H, Fixed, 95% CI)	7.8 [2.19, 27.77]
1.4 Ropivacaine	1	45	Risk Ratio (M‐H, Fixed, 95% CI)	5.81 [0.25, 134.73]
1.5 Levobupivacaine	1	45	Risk Ratio (M‐H, Fixed, 95% CI)	9.69 [0.49, 189.93]

Comparison 2. Lidocaine versus other local anaesthetic (excluding mepivacaine)

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Referencias

Referencias de los estudios incluidos en esta revisión

Aouad 2001 {published data only}

Breebaart 2003 {published data only}

de Weert 2000 {published and unpublished data}

Hampl 1995b {published data only}

Hampl 1998 {published data only}

Hodgson 2000 {published data only}

Keld 2000 {published and unpublished data}

Le Truong 2001 {published and unpublished data}

Liguori 1998 {published data only}

Martinez‐Bourio 1998 {published data only}

Philip 2001 {published data only}

Pollock 1996 {published data only}

Salazar 2001 {published and unpublished data}

Salmela 1998 {published data only}

Østgaard 2000 {published and unpublished data}

Referencias de los estudios excluidos de esta revisión

Ben‐David 2000 {published data only}

Bergeron 1999 {published data only}

Chan 1998 {published data only}

Frey 1998 {published data only}

Gentili 1997 {published data only}

Hampl 1995a {published data only}

Hampl 1996 {published data only}

Henderson 1998 {published data only}

Hiller 1999 {published data only}

Liam 1998 {published data only}

Loo 1999 {published data only}

Markey 1997 {published data only}

Morisaki 1998 {published data only}

Murto 1999 {published data only}

Pawlowski 2000 {published data only}

Pollock 1999 {published data only}

Salmela 1996 {published data only}

Sia 1998 {published data only}

Tong 2003 {published data only}

Wong 1999 {published data only}

Zayas 1999 {published data only}

Referencias adicionales

Altman 2003

Auroy 1997

Axelrod 1998

Bier 1899

Casati 1998

Corbey 1998

Dahlgren 1995

Douglas 1995

Drasner 1997

Freedman 1998

Gerancher 1997

Gielen 1986

Green 1961

Hiller 1997

Holmdahl 1998

Horlocker 2000

Iselin‐Chaves 1996

Kane 1981

Li 1985

Liu 1998

Lynch 1997

Masuda 1998

McKeown 1986

Noble 1971

Phillips 1969

Pollock 2000

Renck 1995

Rigler 1991

Sawyer 2000

Schell 1991

Schneider 1993

Selander 1988

Sumi 1996

Tagariello 1998

Tarkkila 1991

Tarkkila 1995

Usubiaga 1975

Vandam 1955