Lidocaine Spinal Anesthesia and Transient Neurologic Symptoms: A Summary of a Joint Replacement Study
Spinal anesthesia is common for hip and knee replacement. Bupivacaine, the usual drug, can cause a long motor block that slows recovery. Lidocaine wears off sooner, which suits same-day surgery, but it has long been linked to transient neurologic symptoms (TNS): new back or thigh pain after the spinal wears off. Older studies reported TNS rates that often topped 20%, so many clinicians stopped using spinal lidocaine. A study in Regional Anesthesia & Pain Medicine looked at how often TNS happens today.
This summary is based on the published abstract; the full paper may include additional detail. Read the abstract on PubMed: https://pubmed.ncbi.nlm.nih.gov/40306737/
What was studied
The authors measured the current rate of TNS after lidocaine spinal anesthesia in adults having total knee or hip replacement, with an established multimodal pain-control protocol (several pain medicines combined).
How it was done
- Design: a retrospective review at a single US health system.
- Patients: 1,026 patients reviewed; 1,011 included in the final analysis.
- Data source: a postoperative block database with questions aimed at TNS, such as new non-surgical back or thigh pain after the spinal resolved.
- Pain protocol: multimodal medicines, including acetaminophen, an anti-inflammatory (NSAID), IV ketamine, and dexamethasone.
Key findings
- TNS was rare: only 2 of 1,011 patients (0.2%) were diagnosed with TNS.
- Symptoms were mild: both cases were self-limited and resolved within 48 to 72 hours.
- No serious complications: there were no cases of prolonged motor or sensory block, cauda equina syndrome, or other significant complications.
- Authors' view: the low rate contrasts sharply with older reports and may reflect the multimodal pain medicines given at the same time.
- Conclusion: lidocaine spinal anesthesia with multimodal analgesia had a negligible TNS rate and may be a reasonable option for outpatient joint replacement.
Limitations
- It was a retrospective review, so some mild cases may have been missed or not reported.
- There was no comparison group, so the study cannot prove the pain protocol caused the low rate.
- It was done at one health system with one protocol; results may differ elsewhere.
- Two authors reported industry education honoraria, as listed with the abstract.
Safety takeaways
- Know the drug choice. Lidocaine and bupivacaine spinals differ in duration and side-effect profile; the choice should fit the patient and the surgery.
- Ask about new back or thigh pain. Follow-up after a lidocaine spinal should screen for TNS once the block wears off.
- Separate TNS from serious problems. New weakness, numbness, or bladder or bowel changes call for prompt evaluation, not reassurance.
- Explain what to expect. Patients should know TNS is usually mild and short-lived, and when to call.
- Document. Record the spinal drug, dose, follow-up questions, and any symptoms.
Reference
- Amaral S, Chen E, Kumar AH, MacLeod DB, Bullock WM, Ray N, Manning E, Martinez-Wilson H, Dooley J, Ohlendorf B, Gadsden J. Incidence of transient neurologic symptoms in patients receiving lidocaine spinal anesthesia for outpatient joint arthroplasty. Reg Anesth Pain Med. 2026;51(5):579-583. DOI: 10.1136/rapm-2025-106541. PMID: 40306737. Abstract: https://pubmed.ncbi.nlm.nih.gov/40306737/
Related: Regional Anesthesia and Nerve Block Cases
This article is educational information, not legal or medical advice.
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