Chloroprocaine versus prilocaine for spinal anesthesia in ambulatory knee arthroscopy: a double-blind randomized trial

Abstract

BackgroundIn ambulatory lower limb surgery, spinal anesthesia with rapid onset and a short duration of block is preferable. We hypothesized that the use of 2-chloroprocaine would be associated with a faster motor block recovery compared with prilocaine in knee arthroscopy. A difference of 15 min was considered clinically relevant.Methods150 patients were randomly allocated to receive intrathecally either 40 mg of 2-chloroprocaine or 40 mg of prilocaine. The primary outcome was the time to complete recovery from motor blockade. Secondary outcomes included time to full regression of sensory block, peak sensory block level, urine retention needing catheterization, time until hospital discharge, incidence of transient neurologic symptoms and patient satisfaction.ResultsTime to complete recovery from motor blockade was 15 min shorter for 2-chloroprocaine (median: 60 min; IQR: 60–82.5) than for prilocaine (median: 75 min; IQR: 60–90; p=0.004). 2-Chloroprocaine also resulted in faster full regression of sensory block (median: 120 min; IQR: 90–135 compared with median: 165 min; IQR: 135–190, p<0.001) and faster time to hospital discharge (mean difference: 57 min; 95% CI 38 to 77, p<0.001). Peak sensory block was higher in the 2-chloroprocaine group (median: T9; IQR: T6–T12 compared with median: T10; IQR: T8–T12, p<0.008). Patient satisfaction and urine retention needing catheterization were equal in both groups.ConclusionsIn knee arthroscopy, spinal anesthesia with 2-chloroprocaine results in a faster recovery of motor and sensory block, leading to quicker hospital discharge compared with prilocaine.Trial registration numberNTR6796.

A Randomized Clinical Trial Comparing Different Concentrations of Chloroprocaine with Lidocaine for Activating Epidural Analgesia During Labor

“…5 In recent years, chloroprocaine has been reintroduced into clinical practice and is widely used in emergency lower abdominal surgery and ambulatory lower limb surgery via epidural or spinal access. [6][7][8] Coppens et al reported that the onset of action was 2-3 min when the drug was administered epidurally for labor analgesia. 8 It has also been used for intrapartum emergency cesarean delivery in patients after labor EA with an onset time of 3-5 minutes, while that of lidocaine is 10-12 minutes.…”

Letter to the Editor Regarding “Impact of Chloroprocaine on the Eligibility for Hospital Discharge in Patients Requiring Ambulatory Surgery Under Spinal Anesthesia: An Observational Multicenter Prospective Study”

“…The most common dose of chloroprocaine administered spinally was 50 mg (59.2%), then 40 mg (32.3%). We recently conducted a double-blind randomized trial comparing 40 mg chloroprocaine with 40 mg prilocaine for spinal anesthesia in ambulatory knee arthroscopy [2]. Using exactly the same discharge criteria, we found that the time from injection to eligibility for hospital discharge in the chloroprocaine arm (40 mg) in our study was substantial shorter, i.e., 222 ± 72 min (mean ± SD).…”

ED90 of spinal 2-chloroprocaine 1% in ambulatory knee arthroscopy up to 45 min: a randomized biased-coin- up-and-down sequential allocation trial

“…Our previous study, in which we compared intrathecal prilocaine and 2-chloroprocaine 1% in ambulatory knee arthroscopy, inspired us to investigate the optimal dose of 2-chloroprocaine 1% for this indication. 2-Chloroprocaine 1% (40 mg) not only showed a faster offset of motor and sensory function than prilocaine (40 mg), it also had high peak levels suggesting a lower dose may further reduce an unnecessary prolonged length of stay 11…”

“…In recent years, preservative-free 2-chloroprocaine 1% has regained interest as short acting spinal anesthetic for lower limb surgery lasting up to 60 min 2. Several double-blind randomized controlled studies have demonstrated that, compared with other local anesthetics, the short duration of block of 2-chloroprocaine 1% favors a fast hospital discharge in outpatient anesthesia 3–11. Our previous study, in which we compared intrathecal prilocaine and 2-chloroprocaine 1% in ambulatory knee arthroscopy, inspired us to investigate the optimal dose of 2-chloroprocaine 1% for this indication.…”