{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T23:25:14Z","timestamp":1786663514237,"version":"build-2736575974"},"reference-count":54,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2020,2,11]],"date-time":"2020-02-11T00:00:00Z","timestamp":1581379200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The use of lidocaine in spinal anesthesia may increase the risk of transient neurological symptoms (TNS) according to previous meta-analyses. However, the previous meta-analyses lacked data on some other local anesthetics and thus, more evaluations are still needed to compare the effect of lidocaine on the development of TNS. The objective of this study was to compare the risk of TNS according to lidocaine versus other local anesthetics in patients undergoing spinal anesthesia. A total of 39 randomized controlled trials with 4733 patients were analyzed. The incidence of TNS was 10.8% in the lidocaine group and was 2.2% in the control groups (risk ratio (RR) 4.12, 95% confidence interval (CI) 3.13 to 5.43, p &lt; 0.001). In subgroup analysis, lidocaine increased the incidence of TNS compared with other local anesthetics except mepivacaine, ropivacaine or sameridine. The risk of TNS was higher in the hyperbaric (p &lt; 0.001) or isobaric lidocaine (p &lt; 0.001) group compared with the control group, but there were no differences found between the two groups when hypobaric lidocaine was administered (p = 1.00). This study confirmed that lidocaine for spinal anesthesia still causes TNS more frequently than most other local anesthetics, especially when hyperbaric or isobaric lidocaine was used.<\/jats:p>","DOI":"10.3390\/jcm9020493","type":"journal-article","created":{"date-parts":[[2020,2,11]],"date-time":"2020-02-11T11:45:30Z","timestamp":1581421530000},"page":"493","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Lidocaine vs. Other Local Anesthetics in the Development of Transient Neurologic Symptoms (TNS) Following Spinal Anesthesia: A Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8567-5514","authenticated-orcid":false,"given":"Chang-Hoon","family":"Koo","sequence":"first","affiliation":[{"name":"Department of Anesthesiology &amp; Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun-Jung","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Hee","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea"},{"name":"Department of Anesthesiology &amp; Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung-Hee","family":"Ryu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea"},{"name":"Department of Anesthesiology &amp; Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,2,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1007\/BF03012094","article-title":"Dose response study of lidocaine 1% for spinal anaesthesia for lower limb and perineal surgery","volume":"45","author":"Liam","year":"1998","journal-title":"Can. J. Anaesth."},{"key":"ref_2","first-page":"CD003006","article-title":"Transient neurologic symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics","volume":"15","author":"Zaric","year":"2009","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_3","first-page":"CD003006","article-title":"Transient neurological symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics in adult surgical patients: A network meta-analysis","volume":"12","author":"Forget","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"21","DOI":"10.4103\/0259-1162.150157","article-title":"Comparison between two different selective spinal anesthesia techniques in ambulatory knee arthroscopy as fast-track anesthesia","volume":"9","year":"2015","journal-title":"Anesth. Essays Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1213\/00000539-200102000-00023","article-title":"Does pregnancy protect against intrathecal lidocaine-induced transient neurologic symptoms?","volume":"92","author":"Aouad","year":"2001","journal-title":"Anesth. Analg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1097\/00000539-200211000-00028","article-title":"Small-dose intrathecal lidocaine versus ropivacaine for anorectal surgery in an ambulatory setting","volume":"95","author":"Buckenmaier","year":"2002","journal-title":"Anesth. Analg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1213\/ANE.0b013e3181ba792e","article-title":"Low-Dose 3 mg Levobupivacaine Plus 10 microg Fentanyl Selective Spinal Anesthesia for Gynecological Outpatient Laparoscopy","volume":"109","author":"Giron","year":"2009","journal-title":"Anesth. Analg."},{"key":"ref_8","first-page":"565","article-title":"Low-dose hypobaric spinal anesthesia for anorectal surgery in jackknife position: Levobupivacaine-fentanyl compared to lidocaine-fentanyl","volume":"57","author":"Giron","year":"2010","journal-title":"Rev. Espaola Anestesiol. Reanim."},{"key":"ref_9","first-page":"113","article-title":"Hypobaric 0.15% bupivacaine versus hypobaric 0.6% lidocaine for posterior spinal anesthesia in outpatient anorectal surgery","volume":"60","author":"Imbelloni","year":"2010","journal-title":"Braz. J. Anestesiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"189","DOI":"10.5152\/tud.2017.14367","article-title":"Low dose lignocaine + butorphanol vs. low dose bupivacaine for spinal anaesthesia in day care urological surgeries: A prospective randomized control trial","volume":"43","author":"Khant","year":"2017","journal-title":"Turk. J. Urol."},{"key":"ref_11","first-page":"S256","article-title":"Hypotension in spinal anesthesia for cesarean section: A comparison of 0.5% hyperbaric bupivacaine and 5% hyperbaric lidocaine","volume":"84","author":"Kyokong","year":"2001","journal-title":"J. Med. Assoc. Thai"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.ambsur.2005.06.005","article-title":"Recovery time and patient satisfaction in ambulatory knee arthroscopy: Prospective study comparing three anaesthetic methods","volume":"12","author":"Martin","year":"2005","journal-title":"Ambul. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1213\/00000539-199904000-00025","article-title":"Sameridine is safe and effective for spinal anesthesia: A comparative dose-ranging study with lidocaine for inguinal hernia repair","volume":"88","author":"Mulroy","year":"1999","journal-title":"Anesth. Analg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.jclinane.2011.06.014","article-title":"Anesthetic and recovery profiles of lidocaine versus mepivacaine for spinal anesthesia in patients undergoing outpatient orthopedic arthroscopic procedures","volume":"24","author":"Pawlowski","year":"2012","journal-title":"J. Clin. Anesth."},{"key":"ref_15","first-page":"30","article-title":"Spinal anesthesia for cesarean section: Comparison of 5.0% lignocaine and 0.5% bupivacaine","volume":"12","author":"Pradhan","year":"2010","journal-title":"Nepal Med. Coll. J."},{"key":"ref_16","first-page":"71","article-title":"Spinal anaesthesia for pelvic surgery: Low concentrations of lignocaine and bupivacaine are effective with less adverse events","volume":"22","author":"Punj","year":"2013","journal-title":"Middle E. J. Anaesthesiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1097\/AAP.0000000000000420","article-title":"Comparison of 2-Chloroprocaine, Bupivacaine, and Lidocaine for Spinal Anesthesia in Patients Undergoing Knee Arthroscopy in an Outpatient Setting: A Double-Blind Randomized Controlled Trial","volume":"41","author":"Teunkens","year":"2016","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.4097\/kjae.1998.35.6.1095","article-title":"Spinal Anesthesia with Hyperbaric 1.5% Lidocaine and 1.5% Mepivacaine","volume":"35","author":"Yea","year":"1998","journal-title":"Korean J. Anesthesiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/j.jclinepi.2009.06.005","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","volume":"62","author":"Moher","year":"2009","journal-title":"J. Clin. Epidemiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Friedrich, J.O., Adhikari, N.K., and Beyene, J. (2007). Inclusion of zero total event trials in meta-analyses maintains analytic consistency and incorporates all available data. BMC Med. Res. Methodol., 7.","DOI":"10.1186\/1471-2288-7-5"},{"key":"ref_22","unstructured":"Higgins, J.P.T., and Green, S. (2011). Cochrane Handbook for Systematic Reviews of Intervetions Version 5.1.0, The Cochrane Collaboration."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1213\/01.ANE.0000068940.36040.54","article-title":"Subarachnoid small-dose bupivacaine versus lidocaine for cervical cerclage","volume":"97","author":"Beilin","year":"2003","journal-title":"Anesth. Analg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1111\/aas.12247","article-title":"Intrathecal chloroprocaine vs. lidocaine in day-case surgery: Recovery, discharge and effect of pre-hydration on micturition","volume":"58","author":"Breebaart","year":"2014","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1093\/bja\/aeg078","article-title":"Urinary bladder scanning after day-case arthroscopy under spinal anaesthesia: Comparison between lidocaine, ropivacaine, and levobupivacaine","volume":"90","author":"Breebaart","year":"2003","journal-title":"Br. J. Anaesth."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1213\/01.ane.0000258766.73612.d8","article-title":"Spinal anesthesia with lidocaine or preservative-free 2-chlorprocaine for outpatient knee arthroscopy: A prospective, randomized, double-blind comparison","volume":"104","author":"Casati","year":"2007","journal-title":"Anesth. Analg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1046\/j.1365-2044.2000.01618-4.x","article-title":"The incidence of transient neurological symptoms after spinal anaesthesia with lidocaine compared to prilocaine","volume":"55","author":"Traksel","year":"2000","journal-title":"Anaesthesia"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"154","DOI":"10.5812\/aapm.6916","article-title":"The effect of needle type, duration of surgery and position of the patient on the risk of transient neurologic symptoms","volume":"2","author":"Etezadi","year":"2013","journal-title":"Anesth. Pain Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1111\/j.1399-6576.2008.01815.x","article-title":"Intrathecal ropivacaine 5 mg\/ml for outpatient knee arthroscopy: A comparison with lidocaine 10 mg\/ml","volume":"53","author":"Fanelli","year":"2009","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1111\/j.1399-6576.2009.02141.x","article-title":"Transient neurological symptoms after spinal anaesthesia with levobupivacaine 5 mg\/ml or lidocaine 20 mg\/ml","volume":"54","author":"Gozdemir","year":"2010","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"27512","DOI":"10.25011\/cim.v39i6.27512","article-title":"Transient neurological symptoms after spinal anesthesia","volume":"39","author":"Gozdemir","year":"2016","journal-title":"Clin. Invest. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1097\/00000542-199803000-00012","article-title":"Transient neurologic symptoms after spinal anesthesia: A lower incidence with prilocaine and bupivacaine than with lidocaine","volume":"88","author":"Hampl","year":"1998","journal-title":"Anesthesiology"},{"key":"ref_33","first-page":"363","article-title":"Hyperosmolarity does not contribute to transient radicular irritation after spinal anesthesia with hyperbaric 5% lidocaine","volume":"20","author":"Hampl","year":"1995","journal-title":"Reg. Anesth."},{"key":"ref_34","first-page":"218","article-title":"Procaine compared with lidocaine for incidence of transient neurologic symptoms","volume":"25","author":"Hodgson","year":"2000","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1034\/j.1399-6576.2000.440311.x","article-title":"The incidence of transient neurologic symptoms (TNS) after spinal anaesthesia in patients undergoing surgery in the supine position. Hyperbaric lidocaine 5% versus hyperbaric bupivacaine 0.5%","volume":"44","author":"Keld","year":"2000","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1007\/BF03028311","article-title":"Spinal anesthesia: A comparison of procaine and lidocaine","volume":"48","author":"Girard","year":"2001","journal-title":"Can. J. Anaesth."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1097\/00000542-199803000-00010","article-title":"Transient neurologic symptoms after spinal anesthesia with mepivacaine and lidocaine","volume":"88","author":"Liguori","year":"1998","journal-title":"Anesthesiology"},{"key":"ref_38","first-page":"109","article-title":"Syndrome of transient radicular irritation secondary to spinal blockade in pelvis traumatologic surgery","volume":"11","author":"Gonzalez","year":"1999","journal-title":"Anest. Mex."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1097\/00000542-199803000-00011","article-title":"Incidence of transient neurologic symptoms after hyperbaric subarachnoid anesthesia with 5% lidocaine and 5% prilocaine","volume":"88","author":"Arzuaga","year":"1998","journal-title":"Anesthesiology"},{"key":"ref_40","unstructured":"Orozco, E.G., Arguelles, R.A.F., Ortega, A.D., and Bastanzuri, M.C.L. (2006). Cost-effectiveness evaluation of 5% lidocaine and 0,5% bupivacaine in spinal anesthesia. Rev. Cubana Farm., 40."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1034\/j.1399-6576.2000.440413.x","article-title":"A randomised study of lidocaine and prilocaine for spinal anaesthesia","volume":"44","author":"Ulveseth","year":"2000","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1213\/00000539-200102000-00024","article-title":"Transient neurologic symptoms after spinal anesthesia with lidocaine in obstetric patients","volume":"92","author":"Philip","year":"2001","journal-title":"Anesth. Analg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1097\/00000542-199606000-00012","article-title":"Prospective study of the incidence of transient radicular irritation in patients undergoing spinal anesthesia","volume":"84","author":"Pollock","year":"1996","journal-title":"Anesthesiology"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1034\/j.1399-6576.2001.450216.x","article-title":"Transient neurologic symptoms after spinal anaesthesia using isobaric 2% mepivacaine and isobaric 2% lidocaine","volume":"45","author":"Salazar","year":"2001","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1111\/j.1399-6576.1998.tb05319.x","article-title":"Transient radicular irritation after spinal anesthesia induced with hyperbaric solutions of cerebrospinal fluid-diluted lidocaine 50 mg\/ml or mepivacaine 40 mg\/ml or bupivacaine 5 mg\/ml","volume":"42","author":"Salmela","year":"1998","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1111\/j.1399-6576.2011.02599.x","article-title":"Selective spinal anesthesia for outpatient transurethral prostatectomy (TURP): Randomized controlled comparison of chloroprocaine with lidocaine","volume":"56","author":"Vaghadia","year":"2012","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1097\/00000542-200105000-00030","article-title":"Current issues in spinal anesthesia","volume":"94","author":"Liu","year":"2001","journal-title":"Anesthesiology"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1111\/aas.12071","article-title":"The use of 2-chloroprocaine for spinal anaesthesia","volume":"57","author":"Goldblum","year":"2013","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1213\/00000539-199611000-00026","article-title":"A similar incidence of transient neurologic symptoms after spinal anesthesia with 2% and 5% lidocaine","volume":"83","author":"Hampl","year":"1996","journal-title":"Anesth. Analg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1097\/00000542-199902000-00019","article-title":"Dilution of spinal lidocaine does not alter the incidence of transient neurologic symptoms","volume":"90","author":"Pollock","year":"1999","journal-title":"Anesthesiology"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1097\/00000542-200302000-00030","article-title":"Prospective study on incidence and functional impact of transient neurologic symptoms associated with 1% versus 5% hyperbaric lidocaine in short urologic procedures","volume":"98","author":"Tong","year":"2003","journal-title":"Anesthesiology"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1097\/00000539-200010000-00018","article-title":"A comparison of minidose lidocaine-fentanyl and conventional-dose lidocaine spinal anesthesia","volume":"91","author":"Maryanovsky","year":"2000","journal-title":"Anesth. Analg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1093\/bja\/aen389","article-title":"Systematic review of spinal anaesthesia using bupivacaine for ambulatory knee arthroscopy","volume":"102","author":"Nair","year":"2009","journal-title":"Br. J. Anaesth."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1097\/00000542-199809000-00012","article-title":"Transient neurologic symptoms symptoms after spinal anesthesia: An epidemiologic study of 1,863 patients","volume":"89","author":"Freedman","year":"1998","journal-title":"Anesthesiology"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/2\/493\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T08:56:57Z","timestamp":1760173017000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/2\/493"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,11]]},"references-count":54,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,2]]}},"alternative-id":["jcm9020493"],"URL":"https:\/\/doi.org\/10.3390\/jcm9020493","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,11]]}}}