Non-alkalinized and alkalinized 2-chloroprocainevs lidocaine for intravenous regional anesthesia during outpatient hand surgery

Abstract

Purpose: Chloroprocaine should be an ideal agent for intravenous regional anesthesia (IVRA) because of its rapid onset and ester hydrolysis. Raising the pH of local anesthetics may increase the speed of onset and the intensity of nerve blocks. We compared plain and alkalinized 2-chloroprocaine 0.5% with lidocaine for IVRA.Methods: In two seporate double-blind studies, 78 patients scheduled for daycare hand surgery were randomized to receive 40 mL plain 2-chloroprocaine 0.5%, alkalinized 2-chloroprocaine 0.5% or lidocaine 0.5% for IVP~. Time to sensory and motor block, need for supplemental analgesia, and side effects were compared. Kesults: There was no difference in time to sensory or motor block in either group. Patients who received plain chloroprocaine required more supplemental opioid and had a higher incidence of metallic taste and of hives than patients who received lidocaine (P < 0.05). Comparing alkalinized chloroprocaine with lidocaine, there was no difference found with respect to opioid supplementation, CNS side effects, or incidence of hives. Conclusion: In conclusion, alkalinized chloroprocaine was found to be an effective agent for IVRA but no benefit over lidocaine was detected. Plain chloroprocaine for IVRA produced more minor side effects than lidocaine.Objectif: La chloroprocaTne est un agent ideal pour ranesth&ie r~gionale intraveineuse (ARIV) &ant donn6 sa rapidit~ d'action et I'hydrolyse des esters. En ~levant le pH des anesth&iques Iocaux, on peut acc~l&er le d~but de I'action et augmenter I'intensit~ des blocages nerveux. Nous avons compar~ la 2-chloroproca'fne simple 0,5 % et alcalinis~e avec la lidoca'fne pour une ARIV.M&hode : II y a eu deux ~tudes s~por4.es, ~ double insu, aupr& de 78 patients dont I'op&ation d'une main avait

Addition of cisatracurium to lidocaine for intravenous regional anesthesia

“…In an attempt to improve perioperative analgesia and to shorten onset time of sensory and motor block, various drugs have been administered concomitantly with the local anesthetic in IVRA with controversial results: morphine [2], fentanyl [3], meperidine [4], aspirin [5], ketorolac [6,7], and bicarbonate [8,9] are among those agents.…”

Pharmacokinetics a>nd Tolerability of Intraperitoneal Chloroprocaine After Fetal Extraction in Women Undergoing Cesarean Delivery

“…This study confirms our hypothesis that the t 1/2 of chloroprocaine after intraperitoneal administration (5.3 minutes) is much longer than the in vitro half-life (11 seconds). However, plasma concentrations remain safely below the lowest concentrations associated with clinical symptoms (2.6-2.9 mg/kg) [26][27][28] and our predefined safe level of exposure (970 µg/kg). Active monitoring did not show any evidence of LAST, therefore, our study suggests that intraperitoneal chloroprocaine, in a dosage ≤1200 mg, administered after fetal extraction, is well tolerated during cesar- Contribution: This author helped with study conception and design, data analysis and interpretation, and writing the manuscript.…”

Case report: Sequential bilateral upper extremity intravenous regional anesthesia with chloroprocaine

“…0.5% 2-chloroprocaine has been used for unilateral IVRA, and its efficacy is equivalent to that induced by 0.5% prilocaine and 0.5% lidocaine. 4,5 The product monograph for 2-chloroprocaine without epinephrine specifies a recommended maximum dose of 11 mgÁkg -1 . A Doses of 2-chloroprocaine up to 2.9 mgÁkg -1 for IVRA were associated with minor systemic toxicity, such as metallic taste, dizziness, and lightheadedness, but no limb twitching after tourniquet deflation.…”

“…A Doses of 2-chloroprocaine up to 2.9 mgÁkg -1 for IVRA were associated with minor systemic toxicity, such as metallic taste, dizziness, and lightheadedness, but no limb twitching after tourniquet deflation. 5 Patient education with respect to minor symptoms of toxicity is important so that early treatment can be initiated without undue anxiety. 2 In our patient, minor twitching was observed after each tourniquet deflation with a dose of 2.78 mgÁkg -1 per side, for a total dose of 5.56 mgÁkg -1 .…”