Transient radiculopathy after 5% lidocaine or 0.75% bupivacaine spinal anesthesia in 3 surgical positions

The present study was conducted to compare the incidence of transient radicular irritation (TRI) after spinal anesthesia with 5% lidocaine or 0.75% bupivacaine in the supine, prone, and lithotomy surgical positions. A non-rAndomized survey approach was used. The convenience sample consisted of 243 adults receiving spinal anesthesia for elective surgery at 1 of 3 hospitals. Patients were questioned by telephone postoperatively to determine whether they had experienced TRI. Statistical analysis using the Fisher exact test revealed no significant difference in TRI incidence between local anesthetics in the supine or prone position groups. In the lithotomy position group, the incidence of TRI was significantly higher in patients receiving 5% lidocaine. Further, chi 2 testing revealed no significant difference in TRI incidence between surgical position groups when position alone was considered. The findings suggest that TRI after spinal anesthesia occurs more frequently with 5% lidocaine than with 0.75% bupivacaine only when patients undergo surgery in the lithotomy position. Providers need to consider the risks and benefits of 5% lidocaine when selecting an agent for spinal anesthesia, especially with patients undergoing surgery in the lithotomy position. When lidocaine is used, providers should discuss TRI as a risk of spinal anesthesia with patients during preanesthetic counseling.