Intrathecal lidocaine and sufentanil shorten postoperative recovery after outpatient rectal surgery

  • Beverly Waxler
  • Shirley A. Mondragon
  • Sonal N. Patel
  • Kochuthresia Nedumgottil
Regional Anesthesia and Pain



A short recovery time for same day surgery is important to the patient and the hospital. A prospective, randomized, doubleblinded study in the postanesthetic care unit was designed to compare the recovery time from spinal anesthesia with low-dose intrathecal (IT) lidocaine and sufentanil to that with IT lidocaine alone. The incidence of adverse effects was also assessed.


Forty-nine patients (ASA I-III, age 20–69 yr) underwent spinal anesthesia for rectal surgery. The patients were randomized into two groups. One group (n = 28) received low-dose IT lidocaine (15 mg) and sufentanil (10 μg) and the other group (n = 21) received IT lidocaine (SO mg). The time to ambulation, the incidence of pruritus, and other variables were recorded. Statistical difference was assumed if P < 0.05.


Our results show a significantly shorter ambulation time (120 ± 26 min) after IT low-dose lidocaine (15 mg) and 10 μg sufentanil vs 50 mg IT lidocaine (162 ± 32 min, P < 0.0001). Patients who received IT lidocaine and sufentanil recovered faster. Fifty percent of the patients who received IT sufentanil suffered from pruritus.


IT lidocaine (15 mg) and sufentanil resulted in a shorter time to ambulation compared to IT lidocaine (50 mg) alone and provided excellent anesthesia despite its disadvantage of pruritus.


Lidocaine Spinal Anesthesia Ketorolac Sufentanil Nalbuphine 

L’administration intrathécale de lidocaïne et de sufentanil diminue le temps de récupération après une opération du rectum en chirurgie ambulatoire



Une récupération rapide en chirurgie ambuiatoire est importante pour ie patient et pour i’hôpital. Une étude prospective, randomisée et à doubie insu a été réaiisée en sale de réveil pour comparer le temps de récupération d’une rachianesthésie avec de faibles doses intrathécaies (IT) de lidocaïne et de sufentanil ou de lidocaïne IT seule. Lincidence d’effets indésirables a aussi été évaluée.


Quaranteneuf patients (ASA I–III, de 20 à 69 ans) ont subi une opération du rectum sous rachianesthésie. Les patients ont été randomises en deux groupes. Dans un groupe (n = 28), ils ont reçu de faibles doses de lidocaïne (15 mg) et de sufentanil (10 μg) IT et dans l’autre (n = 21), ils ont reçu de la lidocaïne (50 mg) IT Le temps requis avant de pouvoir marcher, l’incidence de prurit et d’autres variables ont été enregistrés. Une différence statistique était considérée si P < 0,05.


Nos résultats montrent un temps significativement plus court avant l’ambulation (120 ± 26 min) suivant de faibles doses de lidocaïne (15 mg) et de 10)μg de sufentanil IT vs 50 mg de lidocaïne IT (162 ± 32 min, P < 0,0001). Les patients qui ont reçu la lidocaïne et le sufentanil IT se sont remis plus rapidement. Cinquante pour cent des patients qui ont eu du sufentanil IT ont souffert de prurit.


La lidocaïne (15 mg) et le sufentanil IT, comparés à la lidocaïne seule (50 mg), permettent une récupération plus rapide de la marche et fournissent une excellente anesthésie malgré l’inconvénient du prurit.


  1. 1.
    Pavlin DJ, Rapp SE, Polissar NL, Malmgren JA, Koerschgen M, Keyes H. Factors affecting discharge time in adult outpatients. Anesth Analg 1998; 87: 816–26.PubMedCrossRefGoogle Scholar
  2. 2.
    Li S, Coloma M, White PF, et al. Comparison of the costs and recovery profiles of three anesthetic techniques for ambulatory anorectal surgery. Anesthesiology 2000; 93: 1225–30.PubMedCrossRefGoogle Scholar
  3. 3.
    Stewart AV, Vaßhadia H, Collins L, Mitchell GW. Small-dose selective spinal anaesthesia for short-duration outpatient gynaecological laparoscopy: recovery characteristics compared with propofol anaesthesia. Br J Anaesth 2001; 86: 570–2.PubMedCrossRefGoogle Scholar
  4. 4.
    Ben-David B, Maryanovsky M, Gurevitch A, et al. A comparison of minidose lidocaine-fentanyl and conventional-dose lidocaine spinal anesthesia. Anesth Analg 2000; 91: 865–70.PubMedCrossRefGoogle Scholar
  5. 5.
    Eberhart LH, Morin AM, Kranke P, Geldner G, Wulf H. Transient neurologic symptoms after spinal anesthesia. A quantitative systematic overview (meta-analysis) of randomized controlled studies (German). Anaesthesist 2002; 51: 539–46.PubMedCrossRefGoogle Scholar
  6. 6.
    Tong D, Wong J, Chung F, 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: 485–94.PubMedCrossRefGoogle Scholar
  7. 7.
    Ben-David B, DeMeo PJ, Lucyk C, Solosko D. Minidose lidocaine-fentanyl spinal anesthesia in ambulatory surgery: prophylactic nalbuphine versus nalbuphine plus droperidol. Anesth Analg 2002; 95: 1596–600.PubMedCrossRefGoogle Scholar
  8. 8.
    Ben-David B, DeMeo PJ, Lucyk C, Solosko D. A comparison of minidose lidocaine-fentanyl spinal anesthesia and local anesthesia/propofol infusion for outpatient knee arthroscopy. Anesth Analg 2001; 93: 319–25.PubMedCrossRefGoogle Scholar
  9. 9.
    Vaghadia H, McLeod DH, Mitchell GW, Merrick PM, Chilvers CR. Small-dose hypobaric lidocaine-fentanyl spinal anesthesia for short duration outpatient laparoscopy. I. A randomized comparison with conventional dose hyperbaric lidocaine. Anesth Analg 1997; 84: 59–64.PubMedCrossRefGoogle Scholar
  10. 10.
    Kam PC, Tan KH. Pruritus-itching for a cause and relief? Anaesthesia 1996; 51: 1133–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Szarvas S, Harmon D, Murphy D. Neuraxial opioidinduced pruritus: a review. J Clin Anesth 2003; 15: 234–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Chaney MA. Side effects of intrathecal and epidural opioids. Can J Anaesth 1995; 42: 891–903.PubMedGoogle Scholar
  13. 13.
    Henderson CL, Schmid J, Vaghadia H, Fowler C, Mitchell GW. Selective spinal anesthesia for outpatient laparoscopy. III: sufentanil vs lidocaine-sufentanil. Can J Anesth 2001; 48: 267–72.PubMedCrossRefGoogle Scholar
  14. 14.
    Dunn SM, Connelly NR, Steinberg RB, et al. Intrathecal sufentanil versus epidural lidocaine with epinephrine and sufentanil for early labor analgesia. Anesth Analg 1998; 87: 331–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Lau WC, Green CR, Faerber GJ, Tait AR, Golembiewski JA. Intrathecal sufentanil for extracorporeal shock wave lithotripsy provides earlier discharge of the outpatient than intrathecal lidocaine. Anesth Analg 1997; 84: 1227–31.PubMedCrossRefGoogle Scholar
  16. 16.
    Saito Y, Kaneko M, Kirihara Y, Sakura S, Kosaka Y. Interaction of intrathecally infused morphine and lidocaine in rats (part I): synergistic antinociceptive effects. Anesthesiology 1998; 89: 1455–63.PubMedCrossRefGoogle Scholar
  17. 17.
    Chilvers CR, Goodwin A, Vaghadia H, Mitchell GW. Selective spinal anesthesia for outpatient laparoscopy. V: pharmacoeconomic comparison vs general anesthesia. Can J Anesth 2001; 48: 279–83.PubMedGoogle Scholar
  18. 18.
    Ferouz F, Norris MC, Leißhton BL. Risk of respiratory arrest after intrathecal sufentanil. Anesth Analg 1997; 85: 1088–90.PubMedCrossRefGoogle Scholar
  19. 19.
    Fournier R, Gamulin Z, Van Gessel E. Respiratory depression after 5 μg of intrathecal sufentanil. Anesth Analg 1998; 87: 1377–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Freedman JM, Li DK, Drasner K, Jaskela MC, Larsen B, Wi S. Transient neurologic symptoms after spinal anesthesia. An epidemiologic study of 1,863 patients. Anesthesiology 1998; 89: 633–41.PubMedCrossRefGoogle Scholar
  21. 21.
    Mulroy ME, Salinas FV, Larkin KL, Polissar NL. Ambulatory surgery patients may be discharged before voiding after short-acting spinal and epidural anesthesia. Anesthesiology 2002; 97: 315–9.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2004

Authors and Affiliations

  • Beverly Waxler
    • 1
  • Shirley A. Mondragon
    • 1
  • Sonal N. Patel
    • 1
  • Kochuthresia Nedumgottil
    • 1
  1. 1.Department of Anesthesiology and Pain ManagementJohn H. Stroger Jr. Hospital of Cook CountyChicagoUSA

Personalised recommendations