[Peridural anesthesia using high volume prilocaine--success rate and patient acceptance. A prospective study of 630...

In a prospective clinical study the follow-up course of 630 lumbar single-shot and continuous epidural anesthetics in young patients (average age 24.5 years) with 20-25 ml prilocaine 2% (epinephrine concentration 1:200,000) and 0.1 mg fentanyl was examined critically. The patients were interviewed postoperatively about this method of anesthesia. In 89% of cases the patients had been found suitable for surgery without any additional medication; 9% of the patients needed 0.1-0.15 mg fentanyl and 2.5-5 mg midazolam i.v. Only in 10/630 cases was supplementary anesthesia needed. During anesthesia a drop in blood pressure by 30% or more of the original value was recorded in 1.4% of patients; 5 patients had obvious simultaneous bradycardia. Nausea and vomiting were observed in 2.5% of cases; in 6 patients the level of peridural anesthesia was as high as T4-5. Postoperatively, 19% of the patients complained of discomfort in the area of the lumbar vertebral column. It subsided significantly 2 days after surgery; in 5.6% of cases patients had micturition disorder needing treatment. In 93% of cases the patients considered the method of anesthesia quite acceptable; in the same circumstances 96.5% said they would prefer epidural block to general anesthesia. The main reasons for this were the possibility of observing the surgical operation (26.8%) and the likelihood of speedy recovery on the same day (24.3%). Epidural block is preferred to any form of general anesthesia according to the experience we have gained in these young patients without essential concomitant diseases and with exact consideration to the contraindications for all operations distal of segments T9 and T10.