In Reply:-We appreciate the comments of Lambert et al. and apologize for incorrectly representing their work. We agree that clarification on this point is important because both laboratory and clinical data support the safety of intrathecal bupivacaine in comparison with other local anesthetic agents.
Although we are convinced of the safety of intrathecal bupivacaine, we believe that, currently, there is insufficient clinical data to warrant the total abandonment of 5% and 2% lidocaine for spinal anesthesia. Despite an incidence of transient radicular irritation of 16% in our study, all patients were recovered and completely asymptomatic at 2-week follow-up. [1]In addition, it is difficult to ignore the long safety record of intrathecal lidocaine. One of the many questions remaining to be answered is, after years of clinical use of subarachnoid lidocaine, why are we only now beginning to see patients with postoperative radicular symptoms? We agree with Lambert et al. that ongoing investigation is essential to answer these questions and to identify other appropriate spinal agents for practitioners seeking an alternative to lidocaine. [2]
Julia E. Pollock, M.D., Joseph M. Neal, M.D., Carol Stephenson, R.N., Carol E. Wiley, M.D., Department of Anesthesiology, Virginia Mason Medical Center, B2-AN 1100 Ninth Avenue, Seattle, Washington 98111, Electronic mail: anejep@vmmc.org.
(Accepted for publication August 19, 1996.)
