Local anaesthetics for spinal anaesthesia in day-case surgery

Abstract: Day-case procedures require a high turnover, high quality and low costs. Lidocaine has long been the gold standard for ambulatory spinal anaesthesia. However, the risk of transient neurological symptoms (TNS) limits its use. The perfect local anaesthetic for spinal anaesthesia in day-case surgery should have fast recovery, fast voiding time and a low risk on TNS and urinary retention. Urinary retention is a result of prolonged sensory blockade of the pelvic nerves and is local anaesthetic dose and potency dependent. As a substitute for lidocaine, several local anaesthetics have been suggested in various doses or combinations with or without additives. However, not all are registered for spinal use or have a short-acting profile. The use of additives has been subject of debate because of possible delay in the recovery of bladder. Recently, the old local anaesthetics chloroprocaine and prilocaine were reintroduced in the market. They provide rapid recovery after spinal anaesthesia in day-case surgery. This chapter gives an overview of the local anaesthetics suitable for spinal anaesthesia in day-case surgery, the advantages and disadvantages and the influence on discharge time and recovery of bladder functio