Prilocaine Safe and Effective for spinal anaesthesia in day surgery settings

In a recent study, Andrea Luigi Ambrosoli and colleagues found the safety and effectiveness of spinal prilocaine for ambulatory surgical procedures involving the lower body. The findings were published in Journal of Anesthesia, Analgesia and Critical Care.

Spinal anesthesia has long been regarded as a safe and reliable option for surgeries involving the lower extremities. However, its application in the ambulatory setting necessitates drugs with fast onset and regression of the motor and sensory block. Enter prilocaine.

This study conducted in an Italian tertiary hospital analyzed data from 3291 procedures performed between 2011 and 2019 to assess the safety profile and incidence of complications associated with spinal prilocaine.

The findings suggests that prilocaine is a valid choice for day surgery procedures. Among the 3291 procedures analyzed, the majority included saphenectomy (28.5%), knee arthroscopy (26.8%), proctologic surgery (15.16%), and inguinal canal surgery (14.9%).

The study identified some anesthesia-related complications, albeit at low rates. Urinary retention affected 1.09% of patients, while lipotimia (a sudden fainting episode) occurred in 0.75%. Postoperative nausea was reported by 0.33% of patients, and arrhythmic events were rare, affecting only 0.18%. Additionally, a single case of persistent hypotension and two cases of persistent hypertension were reported.

Persistent motor or sensory blocks, which lasted longer than five hours, were experienced by seven patients. Only one patient (0.03%), who had undergone knee arthroscopy, reported pelvic pain lasting six hours, indicative of a transient neurological symptom.

Proctologic surgery was identified as a factor associated with unplanned admissions due to anesthesia-related complications. The odds of such admissions were 4.9 times higher for this specific surgical procedure.

The study suggests that spinal prilocaine is a safe and effective choice for a range of ambulatory procedures, with a low incidence of complications and the need for hospitalization. However, researchers underscore the importance of conducting further trials to investigate potential complications in the days following the procedure. Further research may continue to refine and expand our understanding of its application in this setting.

Source:

Ambrosoli, A. L., Di Carlo, S., Crespi, A., Severgnini, P., Fedele, L. L., Cofini, V., Necozione, S., & Musella, G. (2023). Safety and effectiveness of prilocaine for spinal anesthesia in day surgery setting: a retrospective study on a sample of 3291 patients. In Journal of Anesthesia, Analgesia and Critical Care (Vol. 3, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s44158-023-00122-6