Intrathecal low-dose bupivacaine versus lidocaine for in vitro fertilization procedures

Recent controversy with the use of intrathecal lidocaine has prompted the search for suitable ambulatory surgery alternatives. The purpose of our study was to evaluate the clinical utility of intrathecal low-dose bupivacaine for outpatient transvaginal oocyte retrieval.

Forty women enrolled and completed our prospective, randomized, double-blinded study of intrathecal hyperbaric bupivacaine 3.75 mg (0.5 mL of 0.75%) with fentanyl 25 microg versus hyperbaric lidocaine 30 mg (2.0 mL of 1.5%) with fentanyl 25 microg. Onset and level of sensory and motor block; time to ambulation, urination, and discharge; and intra- and postoperative complications (hypotension, pruritus, nausea, emesis, postdural puncture headache, post spinal pain syndrome [PSPS]) were recorded. Data were evaluated using analysis of variance, chi-squared, and Mann-Whitney U tests, with P <.05 considered significant.

In demographically similar groups, no differences were noted in times to onset and recovery of sensory and motor function, or complications; however, times to voiding and discharge were significantly longer in the bupivacaine group. Four and 2 patients in the bupivacaine and lidocaine groups, respectively, required intravenous analgesic supplementation. One patient in the lidocaine group experienced PSPS.

Although prolongation to voiding and discharge was observed, intrathecal hyperbaric bupivacaine 3.75 mg with fentanyl 25 microg is a viable anesthetic for oocyte retrieval.