Zaric D, Christiansen C, Pace N L, Punjasawadwong Y
Department of Anaesthesiology, University of Copenhagen, Frederiksberg Hospital, Denmark, Nordre Fasanvej 57, Frederiksberg, Denmark.
Cochrane Database Syst Rev. 2003(2):CD003006. doi: 10.1002/14651858.CD003006.
Spinal anaesthesia has been in use since the turn of the late 19th century. The most serious complication of this technique is damage to the spinal cord or nerve roots resulting in lasting neurologic sequelae. Such serious adverse effects seldom happen. There has been an increase in the number of reports during the last nine years implicating lidocaine as a possible cause of temporary and permanent neurologic complications after spinal anaesthesia. Follow-up of patients who received uncomplicated spinal anaesthesia revealed that some of them developed pain in the lower extremities after an initial full recovery. This painful condition that occurs in the immediate post-operative period was named "transient neurologic symptoms" (TNS).
The objectives of this review were to study the frequency of TNS and neurologic complications after spinal anaesthesia with lidocaine, compared to other local anaesthetics.
Trials were identified by computerized searches of the Cochrane Controlled Trials Register (4th Quarter 2002), MEDLINE (1966 - January 2003), LILAC database, EMBASE (1980 - week 51, 2002), and by checking the reference lists of trials and review articles.
All randomized and pseudo-randomized studies comparing the frequency of TNS and of neurologic complications after spinal anaesthesia with lidocaine as compared to other local anaesthetics.
Two reviewers independently evaluated the quality of the relevant studies and extracted the data from the included studies.
Fourteen trials, reporting 1,349 patients, 117 of whom developed transient neurologic symptoms, were included in the analysis. The use of lidocaine for spinal anaesthesia increased the risk of developing TNS. There was no evidence that this painful condition was associated with any neurologic pathology as it was clearly documented that no positive neurologic findings were present in any patient with TNS; the symptoms disappeared spontaneously by the fifth postoperative day. The relative risk for developing TNS after spinal anaesthesia with lidocaine as compared to other local anaesthetics (bupivacaine, prilocaine, procaine and mepivacaine) was 4.35 (95% Confidence Interval: 1.98, 9.54).
REVIEWER'S CONCLUSIONS: The risk of developing TNS after spinal anaesthesia with lidocaine was significantly higher than when bupivacaine, prilocaine and procaine were used. The term "TNS", which implies a positive neurologic finding, should not be used for this painful condition, which is in fact comparable to another common adverse effect after spinal anaesthesia - lower back pain. How much the pain in the lower extremities influences patient satisfaction is not elucidated clearly in the literature.
自19世纪末以来，脊髓麻醉一直在使用。该技术最严重的并发症是脊髓或神经根损伤，导致永久性神经后遗症。这种严重的不良反应很少发生。在过去九年中，有越来越多的报告指出利多卡因可能是脊髓麻醉后导致暂时和永久性神经并发症的原因。对接受无并发症脊髓麻醉的患者进行随访发现，其中一些患者在最初完全康复后出现下肢疼痛。这种在术后即刻出现的疼痛状况被称为“短暂性神经症状”（TNS）。
本综述的目的是研究与其他局部麻醉剂相比，利多卡因用于脊髓麻醉后TNS和神经并发症的发生率。
通过计算机检索Cochrane对照试验注册库（2002年第4季度）、MEDLINE（1966年 - 2003年1月）、LILAC数据库、EMBASE（1980年 - 2002年第51周），并查阅试验和综述文章的参考文献列表来确定试验。
所有比较利多卡因与其他局部麻醉剂用于脊髓麻醉后TNS和神经并发症发生率差异的随机和半随机研究。
两名评价者独立评估相关研究的质量，并从纳入研究中提取数据。
14项试验，共报告1349例患者，其中117例出现短暂性神经症状，纳入分析。使用利多卡因进行脊髓麻醉会增加发生TNS的风险。没有证据表明这种疼痛状况与任何神经病理学有关，因为有明确记录显示，任何TNS患者均未出现阳性神经学发现；症状在术后第5天自行消失。与其他局部麻醉剂（布比卡因﹑丙胺卡因﹑普鲁卡因和美普卡因）相比，利多卡因用于脊髓麻醉后发生TNS的相对风险为4.35（95%置信区间：1.98，9.54）。
与使用布比卡因、丙胺卡因和普鲁卡因相比，利多卡因用于脊髓麻醉后发生TNS的风险显著更高。“TNS”一词暗示有阳性神经学发现，不应将其用于这种疼痛状况，实际上它与脊髓麻醉后的另一种常见不良反应——腰痛相当。下肢疼痛对患者满意度的影响在文献中并未明确阐明。
