Early Recovery Outcomes Following Low-Dose Spinal Anesthesia in Day-Care Surgery

Abstract

Conventional spinal anesthesia has long been viewed with suspicion in day-care surgery because of prolonged motor block and unpredictable bladder recovery, and over the past two decades anesthesiologists have responded by reshaping rather than abandoning the technique. This review examines the comparative evidence for low-dose and selective spinal anesthesia strategies in ambulatory practice, including unilateral and dose-reduced bupivacaine technique, short-acting ester local anesthetics such as 2-chloroprocaine and prilocaine, and low-dose opioid adjuncts. The literature indicates that restricting local anesthetic distribution and dose, or switching to genuinely short-acting agents, reliably shortens motor recovery and time to discharge readiness without compromising surgical anesthesia, while intrathecal fentanyl extends block adequacy without meaningfully delaying recovery, unlike intrathecal morphine. Relaxing mandatory in-hospital voiding requirements for low-risk patients further removes a major, previously underappreciated bottleneck to same-day discharge that persists independent of block resolution. We conclude that these combined modifications have made spinal anesthesia a genuinely competitive option against general anesthesia and peripheral nerve block for ambulatory surgery, though head-to-head trials using time-to-discharge as a primary endpoint remain comparatively scarce.