Spinal anesthesia has become increasingly popular for inpatient surgery, but, until recently,
its use has been limited in ambulatory surgery due to the lack of a safe and licensed
short-acting local anesthetic agent. An ideal intrathecal agent for ambulatory surgery should
have a rapid onset of motor and sensory blockade, predictable regression within an acceptable
time frame, and a low incidence of adverse effects. Hyperbaric Bupivacaine is a long-acting
local anesthetic from the amide group and has a low incidence of transient neurological
symptoms (TNS). Because of its pharmacological profile, the recovery of motor and sensory
blocks is delayed compared to short-acting local anesthetics. The incidence of postoperative
urinary retention with long-acting local anesthetics like bupivacaine is higher than with
short-acting local anesthetics . Successful spinal anesthesia with low doses of bupivacaine
between 5 and 10 mg without additives has been described for outpatients. The incidence of
urinary retention was still 3.7-16%. Furthermore, with these low doses, block height becomes
unpredictable, and the risk of block failure is high . Prilocaine is an amide local
anesthetic with an intermediate duration of action after spinal administration. Recently, the
old local anesthetics prilocaine was reintroduced in the market. It is available in the
hyperbaric form and provides anesthesia for 75-90 min after spinal administration .
Hyperbaric prilocaine 2% is increasingly used for spinal anesthesia in the ambulatory setting
, as it has the advantage of faster recovery times than hyperbaric bupivacaine . We aimed to
compare spinal anesthesia using hyperbaric prilocaine 2% and hyperbaric bupivacaine 0.5% for
day case surgery in terms of sensory block, and motor block resolution times. The time for
first spontaneous voiding and duration of stay in the PACU and time to home readiness.
Vascular disease and cardiac dysfunction are linked in many ways. They share common risk
factors and comorbidities, and patients with systemic vascular disease often have concomitant
heart disease, because the blood vessels of the heart are not spared. In patients presenting
for surgery, the presence of vascular disease puts the patient at increased risk for
perioperative cardiac complications, and vascular surgery poses the highest surgical risk for
perioperative cardiac events.
In addition, the diseased vessels supplying critical organs depend on the perfusion pressure
supplied by the heart, so any cardiac dysfunction thus amplifies the effect of poor
perfusion. Patients presenting with both vascular disease and cardiac dysfunction pose a
particular challenge to the anesthesiologist; although treatment goals are similar small
physiologic disturbances can quickly lead to large, serious changes in clinical status.
Selective spinal anesthesia performed with a short-term hyperbaric local anesthetic could be
a perfect solution, because it guarantees rapid sensory and motor block, predictable
duration, and low incidence of side effects. It is usually well accepted by both patients and
surgeons due to its high reliability, as it provides effective analgesia, with minimal side
effects, rapid changeover times, and low costs .