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To the Editor: A Clinical Crossroads article¹ describes a woman who was dissatisfied with the medical care she received during and after her outpatient surgery. In her discussion, Dr Daley criticized the use of spinal bupivacaine instead of lidocaine, which caused the patient to experience several additional hours of unexpected anesthesia. Daley speculates that this choice was based on the anesthetic's duration of action. In an accompanying Editorial, Dr Eisenberg² accuses the anesthesiologist of violating "the elementary norms of ethical behavior."

Many anesthesiologists have stopped using spinal lidocaine because it is the local anesthetic most likely to cause transient neurological symptoms (TNS), especially for knee arthroscopy performed on an ambulatory basis.^3-4 Personally, I would rather rest a few extra hours in the recovery area than worry about and possibly experience a painful recovery at home. Bupivacaine is not the expedient choice and, with the longer postoperative stay, not the cheaper . . . [Full Text of this Article]

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