[Spinal anaesthesia in day-case surgery. Optimisation of procedures]

Area of Science:

• Anesthesiology
• Pharmacology

Background:

• Prilocaine is increasingly used for day case surgery requiring spinal anesthesia.
• It offers a low risk for transient neurological symptoms, prompting comparison with bupivacaine.

Purpose of the Study:

• To compare the efficacy and safety of hyperbaric prilocaine versus hyperbaric bupivacaine for spinal anesthesia in lower limb surgery.

Main Methods:

• A randomized study involving 88 patients undergoing lower limb surgery with spinal anesthesia.
• Patients received either 15 mg hyperbaric bupivacaine 0.5% or 60 mg hyperbaric prilocaine 2% in a sitting position.
• Onset, intensity, duration of sensomotoric block, vital signs, and time to spontaneous miction were recorded.

Main Results:

• Bupivacaine induced a significantly higher sensory block (T6) than prilocaine (T8).
• Both agents achieved similar block intensity and onset times, with both reaching an analgesic level of at least T12.
• Prilocaine provided a shorter duration of analgesia (60 min vs. 120 min), motor block regression (135 min vs. 210 min), sensory block resolution (240 min vs. 360 min), and time to spontaneous miction (306 min vs. 405 min) compared to bupivacaine.

Conclusions:

• Hyperbaric prilocaine 2% demonstrated a superior shorter effect profile compared to hyperbaric bupivacaine 0.5%, with equivalent block quality.
• The findings suggest prilocaine is a suitable alternative for spinal anesthesia in day case surgery.
• Positioning techniques may influence sacral block and bladder function recovery.