A Randomised Test Comparing Serum hs-CRP and hs-Troponin Concentration when Prilocaine 2% and Hyperbaric Lidocaine 5% are Used in Cystoscopy

Anaesthesia use has a depressant effect on the cardiovascular system during surgery. The decreasing blood pressure as the heart and blood vessels through sodium channel activity reduces cardiac output and induces vasodilation. The analgesic sympathetic blockade effect is associated with hypotension, characterised by a decline in glomerular filtration rate (eGFR), which, in turn, escalates two biomarkers: troponin and high-sensitivity C-reactive protein (hs-CRP) concentration. Serum troponin signals ischemia while hs-CRP indicates systemic inflammation. In this study, the cardiac and inflammatory responses associated with using Lidocaine and Prilocaine as subarachnoid blocks for spinal surgery is investigated. The authors intend to compare newcomer drug (Prilocaine) as to be considered for alternative local anaesthesia use instead of Lidocaine 5% that has been widely used for a long time in the nation.

In this parallel randomised, controlled, double-blind trial design, two groups (identified as P and L), each comprising 45 participants were elected for Hyperbaric Lidocaine 5% and Prilocaine 2% treatment. The subjects’ blood was drawn twice (within 24 hours preoperatively and 4 hours postoperatively) for cardiac and inflammatory response assessment based on Troponin and serum hs-CRP concentrations respectively.

Group P had a lower incidence of hypotension, bradycardia, and nausea. In group P, hs-CRP (1.58±1.58mg/dL vs 4.09±1.60mg/dL with p<0.001(α<.05 two tailed) and postoperative hs-Troponin (3.47±2.0ng/L vs 5.64±2.61ng/L with p<0.001(α<.05 two tailed). The concentration of troponin and Serum hs-CRP were lower compared with group L.

Cardiac and inflammatory response were higher in prilocaine than lidocaine group as indicated by the lower serum hs-CRP and troponin concentration level in the former group, implying that prilocaine 2% induces lower cardiovascular dysfunction effect as shown by a lower increment of hs-Troponin level, and fewer side effects like bradycardia, and nausea.