Prilocaine hydrochloride 2% hyperbaric solution for intrathecal injection: a clinical review

Alberto Manassero, Andrea Fanelli, Alberto Manassero, Andrea Fanelli

Abstract

Prilocaine is a local anesthetic characterized by intermediate potency and duration and fast onset of action. As hyperbaric formulation of 5% solution, it was introduced and has been successfully used for spinal anesthesia since 1960. A new formulation of 2% plain and hyperbaric solution is currently available in Europe. Because of its lower incidence of transient neurological symptoms, prilocaine is suggested as substitute to lidocaine and mepivacaine in spinal anesthesia for ambulatory surgery, as well as a suitable alternative to low doses of long-acting local anesthetics. The National Library of Medicine database, the Excerpta Medica database, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials database, were searched for the period 1970 to September 2016, with the aim to identify studies evaluating the intrathecal use of 2% prilocaine. A total of 13 randomized clinical trials (RCTs), 1 observational study, 2 dose finding, and 4 systematic reviews has been used for this review. The studies evaluated showed that 2% hyperbaric prilocaine due to a favorable anesthetic and safety profile is an alternative drug to lidocaine and mepivacaine for spinal anesthesia of intermediate or short duration. In comparison with plain solutions, hyperbaricity remarkably accelerates the onset and offset times of intrathecal 2% prilocaine. Literature suggests a dose ranging between 40 and 60 mg of prilocaine for lower extremities and lower abdominal procedures lasting up to 90 min, whereas a dose ranging from 10 to 30 mg is appropriate for perineal surgery. Readiness for discharge occurs in ~4 h from spinal administration.

Keywords: day surgery; postoperative urinary retention; short acting local anesthetic; spinal anesthesia; transient neurologic symptoms.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

References

    1. Förster JG. Short-acting spinal anesthesia in the ambulatory setting. Curr Opin Anaesthesiol. 2014;27(6):597–604.
    1. Schneider M, Ettlin T, Kaufmann M, et al. Transient neurologic toxicity after hyperbaric subarachnoid anesthesia with 5% lidocaine. Anesth Analg. 1993;76(5):1154–1157.
    1. Tarkkila P, Huhtala J, Tuominen M. Transient radicular irritation after spinal anesthesia with hyperbaric 5% lignocaine. Br J Anaesth. 1995;74(3):328–329.
    1. Hiller A, Rosenberg PH. Transient neurological symptoms after spinal anaesthesia with 4% mepivacaine and 0.5% bupivacaine. Br J Anaesth. 1997;79(3):301–305.
    1. 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(3):633–641.
    1. Hodgson PS, Liu SS, Batra MS, Gras TW, Pollock JE, Neal JM. Procaine compared with lidocaine for incidence of transient neurologic symptoms. Reg Anesth Pain Med. 2000;25(3):218–222.
    1. Liu SS, Ware PD, Allen HW, Neal JM, Pollock JE. Dose-response characteristics of spinal bupivacaine in volunteers. Clinical implications for ambulatory anesthesia. Anesthesiology. 1996;89(6):729–736.
    1. Nair GS, Abrishami A, Lermitte J, Chung F. Systematic review of spinal anaesthesia using bupivacaine for ambulatory knee arthroscopy. Br J Anaesth. 2009;102(3):307–315.
    1. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12.
    1. Tucker GT, Mather LE. Clinical Pharmacokinetics of local anaesthetics. Clin Pharmacokinet. 1979;4(4):241–278.
    1. Hardman JD, Limbird LE, Molinoff RW, Ruddon AG. In: The Pharmacological Basis of Therapeutics. Goodman LS, Gilman A, editors. New York, NY: McGraw-Hill; 1996. p. 338.
    1. Vasters FG, Eberhart LH, Koch T, Kranke P, Wulf H, Morin AM. Risk factors for prilocaine-induced methaemoglobinaemia following peripheral regional anaesthesia. Eur J Anaesthesiol. 2006;23(9):760–765.
    1. Crankshaw TP. Citanest (Prilocaine) in spinal analgesia. Acta Anaesth Scand. 1965;9(s16):287–290.
    1. Hillmann KM. Spinal prilocaine. Anaesthesia. 1978;33(1):68–69.
    1. Robertson DH. Spinal prilocaine. Anaesthesia. 1978;33(7):647–648.
    1. Hocking G, Wildsmith JA. Intrathecal drug spread. Br J Anaesth. 2004;93(4):568–578.
    1. McLeod GA. Density of spinal anaesthetic solutions of bupivacaine, levobupivacaine and ropivacaine with and without dextrose. Br J Anaesth. 2004;92(4):547–551.
    1. Bachmann M, Pere P, Kairaluoma P, Rosenberg PH, Kallio H. Comparison of hyperbaric and plain articaine in spinal anaesthesia for open inguinal hernia repair. Br J Anaesth. 2008;101(6):848–854.
    1. Sen H, Purtuloglu T, Sizlan A, et al. Comparison of intrathecal hyper-baric and isobaric levobupivacaine in urological surgery. Minerva Anestesiol. 2010;76(1):24–28.
    1. Fettes P, Hocking G, Peterson M, Luck JF, Wildsmith JA. Comparison of plain and hyperbaric solutions of ropivacaine for spinal anaesthesia. Br J Anaesth. 2005;94(1):107–111.
    1. Kooger Infante NE, Van Gessel E, Forster A, Gamulin Z. Extent of hyperbaric spinal anesthesia influences the duration of spinal block. Anesthesiology. 2000;92(5):1319–1323.
    1. Camponovo C, Fanelli A, Ghisi D, Cristina D, Fanelli G. A prospective, prospective, double-blinded, randomized, clinical trial comparing the efficacy of 40 mg and 60 mg hyperbaric 2prilocaine versus 60 mg plain prilocaine for intathecal anesthesia in ambulatory surgery. Anesth Analg. 2010;111(2):568–572.
    1. Rätsch G, Niebergall H, Hauenstein L, Reber A. Spinal anaesthesia in day-case surgery. Optimisation of procedures. Anaesthesist. 2007;56(4):322–327.
    1. Enk D, Prien T, Van Aken H, Mertes N, Meyer J, Brűssel T. Success rate of unilateral spinal anesthesia is dependent on injection flow. Reg Anesth Pain Med. 2001;26(5):420–427.
    1. Casati A, Fanelli G, Aldegheri G, et al. Frequency of hypotension during conventional or asymmetric hyperbaric spinal block. Reg Anesth Pain Med. 1999;24(3):214–219.
    1. Manassero A, Bossolasco M, Ugues S, Bailo C, Liarou C, Coletta G. Comparison of unilateral and bilateral spinal anesthesia with 2% hyperbaric prilocaine in day-case inguinal herniorraphy: a randomized controlled trial. Minerva Anestesiol. 2014;80(6):685–691.
    1. Gebhardt V, Herold A, Weiss C, Samakas A, Schmittner MD. Dosage finding for low-dose spinal anaesthesia using hyperbaric prilocaine in patients undergoing perianal outpatient surgery. Acta Anaesthesiol Scand. 2013;57(2):249–256.
    1. Gebhardt V, Beilstein B, Herold A, et al. Spinal hyperbaric prilocaine versus. mepivacaine in perianal outpatient surgery. Central Eur J Med. 2014;9(6):754–761.
    1. Kaban OG, Yazicioglu D, Akkaya T, Sayin MM, Seker D, Gumus H. Spinal anaesthesia with hyperbaric prilocaine in day-case perianal surgery: randomised controlled trial. Scientific World Journal. 2014;2014:608372.
    1. Guntz E, Latrech B, Tsiberidis C, Gouwy J, Kapessidou Y. ED 50 and ED 90 of intrathecal hyperbaric 2% prilocaine in ambulatory knee arthroscopy. Can J Anesth. 2014;61(9):801–807.
    1. Ambrosoli AL, Chiaranda M, Fedele LL, Gemma M, Cedrati V, Cap-pelleri GA. Randomised controlled trial of intrathecal blockade versus peripheral nerve blockade for day-case knee arthroscopy. Anaesthesia. 2016;71(3):280–284.
    1. Aguirre J, Borgeat A, Bühler P, Mrdjen J, Hardmeier B, Bonvini JM. Intrathecal hyperbaric 2% prilocaine versus 0.4% plain ropivacaine for same-day arthroscopic knee surgery: a prospective randomized, double-blind controlled study. Can J Anesth. 2015;62(10):1055–1062.
    1. Manassero A, Meconi T, Fanelli A. Is 60 mg a suitable dosage for same-day spinal prilocaine? Can J Anesth. 2016;63(4):495–496.
    1. Guntz E, Kapessidou Y. Spinal prilocaine for same-day surgery: the importance of equipotent doses. Can J Anesth. 2016;63(8):985–986.
    1. Hendriks MP, De Weert CJM, Snoeck MMJ, Hu HP, Pluim MAL, Gielen MJM. Plain articaine or prilocaine for spinal anaesthesia in day-case knee arthroscopy: a double-blind randomized trial. Br J Anaesth. 2009;102(2):259–263.
    1. Black AS, Newcombe GN, Plummer JL, McLeod DH, Martin DK. Spinal anaesthesia for ambulatory arthroscopic surgery of the knee: a comparison of low-dose prilocaine and fentanyl with bupivacaine and fentanyl. Br J Anaesth. 2011;106(2):183–188.
    1. Akcaboy ZN, Akcaboy ET, Mutlu NM, Serger N, Aksu C, Gogus N. Spinal anesthesia with low-dose bupivacaine-fentanyl combination: a good alternative for day case transurethral resection of prostate surgery in geriatric patients. Rev Bras Anestesiol. 2012;62(6):753–761.
    1. Kamphuis ET, Ionescu TI, Kuipers PW, de Gier J, van Venrooij GE, Boon TA. Recovery of storage and emptying functions of the urinary bladder after spinal anesthesia with lidocaine and with bupivacaine in men. Anesthesiology. 1998;88(2):310–316.
    1. Kreutziger J, Frankenberger B, Luger TJ, Richard S, Zbinden S. Urinary retention after spinal anaesthesia with hyperbaric prilocaine 2% in an ambulatory setting. Br J Anaesth. 2010;104(5):582–586.
    1. Pavlin DJ, Pavlin EG, Gunn HC, Taraday JK, Koerschgen ME. Voiding in patients managed with or without ultrasound monitoring of bladder volume after outpatient surgery. Anesth Analg. 1999;89(1):90–97.
    1. Awad IT, Chung F. Factors affecting recovery and discharge following ambulatory surgery. Can J Anesth. 2006;53(9):858–872.
    1. Mulroy MF, Salinas FV, Larkin KL, Polissar L. Ambulatory surgery patients may be discharged before voiding after short-acting spinal and epidural anesthesia. Anesthesiology. 2002;97(2):315–319.
    1. Hampl KF, Schneider MC, Ummenhofer W, Drewe J. Transient neurologic symptoms after spinal anesthesia. Anesth Analg. 1995;81(6):1148–1153.
    1. Hampl KF, Schneider MC, Pargger H, Gut J, Drewe J, Drasner K. A similar incidence of transient neurologic symptoms after spinal anesthe-sia with 2% and 5% lidocaine. Anesth Analg. 1996;83(5):1051–1054.
    1. Pollok JE. Transient neurologic symptoms: etiology, risk factors, and management. Reg Anesth Pain Med. 2002;27(6):581–586.
    1. Pollock JE. Neurotoxicity of intrathecal local anaesthetics and transient neurological symptoms. Best Pract Res Clin Anaesthesiol. 2003;17(3):471–484.
    1. Hampl KF, Heinzmann-Wiedmer S, Luginbuehl I, et al. Transient neurologic symptoms after spinal anestesia: a lower incidence with prilocaine and bupivacaine than with lidocaine. Anesthesiology. 1988;88(3):629–633.
    1. Martìnez-Bourio R, Arzuaga M, Quintana JM, et al. Incidence of transient neurologic symptoms after hyperbaric subarachnoid anesthesia with 5% lidocaine and 5% prilocaine. Anesthesiology. 1998;88(3):624–628.
    1. König W, Ruzicic D. Absence of transient radicular irritation after 5000 spinal anaesthetics with prilocaine. Anaesthesia. 1997;52(2):182–183.
    1. De Weert K, Traskel M, Gielen M, Slappendel R, Weber E, Dirksen R. The incidence of transient neurological symptoms after spinal anaesthesia with lidocaine compared to prilocaine. Anaesthesia. 2000;55(10):1020–1024.
    1. Østgaard G, Hallaråker O, Ulveseth OK, Flaatten H. A randomised study of lidocaine and prilocaine for spinal anaesthesia. Acta Anaesthesiol Scand. 2000;44(4):436–440.
    1. Eberhart LH, Morin AM, Kranke P, Geldner G, Wulf H. Transient neurologic symptoms after spinal anesthesia. A quantitative systematic review (meta-analysis) of randomized controlled studies. Anaesthesist. 2002;51:539–546.
    1. Zaric D, Pace NL, Christiansen C, Punjasawadwong Y. Transient neurological symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics. Cochrane Database Syst Rev. 2003;(2):CD003006.
    1. Zaric D, Christiansen C, Pace NL, Punjasawadwong Y. Transient neurological symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics: a systematic review of randomized, controlled trials. Anaesth Analg. 2005;100(6):1811–1816.
    1. Zaric D, Pace NL. Transient neurologic symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics. Cochrane Database Syst Rev. 2009;15(2):CD003006.
    1. [homepage on the Internet] University of Oxford: The Centre for Evidence-Based Medicine. Nov, 1998. [Accessed February 26, 2017]. [Updated by Jeremy Howick March 2009]. Available from:

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