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The Effect of Subarachnoid Lidocaine and Combined Subarachnoid Lidocaine and Epidural Bupivacaine on Electrical Sensory Thresholds
  1. William E. Dirkes, M.D.*,
  2. Henrik Kehlet, M.D., PH.D.**,
  3. Jacob Rosenberg, M.D.** and
  4. Claus Lund, M.D.**
  1. *Department of Anesthesia, University of Cincinnati College of Medicine, Cincinnati, Ohio
  2. **Department of Anesthesia and Surgical Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark


Eight patients undergoing abdominal surgery received a combination of spinal anesthesia (catheter at L2-3 level) and epidural anesthesia (catheter at T10-11 level). Sensory thresholds to electrical stimulation were measured at the S1, L1, T10, and T5 levels before injection, after spinal anesthesia, and after the addition of epidural anesthesia. Subarachnoid injections with 5% lidocaine (without dextrose) were given until a T4 sensory level to pinprick was obtained (mean dose, 175 mg lidocaine). The mean sensory thresholds were increased from 2.2 ± 0.3, 2.4 ± 0.4, 2.9 ± 0.4, and 3.8 ± 0.4 mA to 21.3 ± 4.3, 13.3 ± 4.9, 10 ± 4.4, and 10.6 ± 4.3 mA, respectively ( p < 0.05 at all levels). The addition of 5 ml 0.5% epidural bupivacaine further increased the mean sensory thresholds to 26.9 ± 3.1, 21.7 ± 4.1, 21.3 ± 4.1, and 17.5 ± 4.7 mA, respectively ( p < 0.05 at all levels). Combined subarachnoid and epidural local anesthetics provide an enhanced afferent block not obtainable by either technique alone.

  • Local anesthetic
  • subarachnoid lidocaine
  • epidural bupivacaine
  • sensory threshold

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