Is There Still a Place for Lidocaine in Spinal Anaesthesia ?

Over the last decade, methods and practice of anaesthesia have changed considerably in favour of regional techniques whenever applicable. Based on data representative for France, which were commissioned by « La Société Française d’Anesthésie et de Réanimation » (SFAR), the percentage of procedures performed under regional anaesthesia has quadrupled between 1980 and 1996 [1]. According to this survey, 16 % of the anaesthetic workload comprised regional anaesthetic techniques among which spinal anaesthesia accounted for the largest part with a share of 37 %. This number represents an estimate of 442,000 spinal anaesthetic procedures performed in 1996 in 1,583 units offering anaesthesia services. Therefore, lack of side-effects attributable to drugs used for spinal anaesthesia is of paramount importance as any postanaesthetic morbidity may impinge on an otherwise rapid postoperative recovery and thus have important economic implications. This chapter focuses on lidocaine’s potential to cause neurological side-effects or even injury, additional data showing the impact of anaesthetic equipment (i.e., needle size and incidence of post-dural puncture headache) on postoperative morbidity will not be included.