Lower-Dose Mepivacaine Plus Fentanyl May Improve Spinal Anesthesia for Knee Arthroscopy |
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Authors: | Richard L Kahn Jennifer Cheng James J Bae Kara Fields John G Muller John D MacGillivray Howard A Rose Riley J Williams III Jacques T YaDeau |
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Institution: | .Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ;.Healthcare Research Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ;.Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA |
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Abstract: | BackgroundPrevious work indicates that 30 mg isobaric mepivacaine 1.5% plus 10 μg fentanyl produces reliable anesthesia for knee arthroscopy with a more rapid recovery profile than 45 mg mepivacaine.Questions/PurposesThis randomized controlled trial compared plain mepivacaine to three reduced doses of mepivacaine with 10 μg fentanyl for spinal anesthesia.MethodsFollowing written informed consent, subjects undergoing outpatient knee arthroscopy were prospectively randomized into one of four groups: mepivacaine 37.5 mg (M37.5); mepivacaine 30 mg plus fentanyl 10 μg (M30/F10); mepivacaine 27 mg plus fentanyl 10 μg (M27/F10); and mepivacaine 24 mg plus fentanyl 10 μg (M24/F10). The spinal was evaluated by the blinded anesthetist and surgeon. In the post-anesthesia care unit, sensory and motor block resolution was assessed. Subjects rated their satisfaction with the overall experience.ResultsGroup M30/F10 (n = 6) had two “fair” anesthetics, and group M27/F10 (n = 10) had one “fair” and one “inadequate” anesthetic. Both groups were eliminated from further enrollment per study protocol. The recovery profiles showed little difference between groups M37.5 and M30/F10, except for motor block resolution (median (25th percentile, 75th percentile): 171 (135, 195) and 128 (120, 135), respectively). Groups M27/F10 and M24/F10 demonstrated recovery profiles that were faster than group M37.5. Patient satisfaction was 10/10 for all groups.ConclusionsAdding fentanyl 10 μg to a lower dose of mepivacaine 1.5% can lead to quicker recovery profiles. However, this advantage of a quicker recovery must be weighed against the likelihood of an incomplete anesthetic.Electronic supplementary materialThe online version of this article (doi:10.1007/s11420-015-9454-8) contains supplementary material, which is available to authorized users. |
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Keywords: | fentanyl mepivacaine spinal anesthesia arthroscopy |
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