Prilocaine hydrochloride 2% hyperbaric solution for intrathecal injection: a clinical review

Abstract

Prilocaine is a local anesthetic characterized by intermediate potency and duration and fast onset of action. As hyperbaric formulation of 5% solution, it was introduced and has been successfully used for spinal anesthesia since 1960. A new formulation of 2% plain and hyperbaric solution is currently available in Europe. Because of its lower incidence of transient neurological symptoms, prilocaine is suggested as substitute to lidocaine and mepivacaine in spinal anesthesia for ambulatory surgery, as well as a suitable alternative to low doses of long-acting local anesthetics. The National Library of Medicine database, the Excerpta Medica database, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials database, were searched for the period 1970 to September 2016, with the aim to identify studies evaluating the intrathecal use of 2% prilocaine. A total of 13 randomized clinical trials (RCTs), 1 observational study, 2 dose finding, and 4 systematic reviews has been used for this review. The studies evaluated showed that 2% hyperbaric prilocaine due to a favorable anesthetic and safety profile is an alternative drug to lidocaine and mepivacaine for spinal anesthesia of intermediate or short duration. In comparison with plain solutions, hyperbaricity remarkably accelerates the onset and offset times of intrathecal 2% prilocaine. Literature suggests a dose ranging between 40 and 60 mg of prilocaine for lower extremities and lower abdominal procedures lasting up to 90 min, whereas a dose ranging from 10 to 30 mg is appropriate for perineal surgery. Readiness for discharge occurs in ~4 h from spinal administration.

Spinal anaesthesia for ambulatory surgery

“…Both drugs are of limited utility in the ambulatory setting because of their long duration of action. 1 Low-dose bupivacaine and 'unilateral' blocks have been used in an attempt to reduce block duration, with limited success. 1 In 2010, hyperbaric prilocaine 2% was licensed for spinal anaesthesia in the UK, followed in 2013 by plain 2chloroprocaine 1%.…”

“…1 Low-dose bupivacaine and 'unilateral' blocks have been used in an attempt to reduce block duration, with limited success. 1 In 2010, hyperbaric prilocaine 2% was licensed for spinal anaesthesia in the UK, followed in 2013 by plain 2chloroprocaine 1%. The US Food and Drug Administration (FDA) approved plain 2-chloroprocaine 1% in 2017.…”

Determination of the ED95 of intrathecal hyperbaric prilocaine with sufentanil for scheduled cesarean delivery: A dose-finding study based on the continual reassessment method

“…Interestingly, our results provide evidence that a dose of HP between 45 and 50 mg is sufficient to ensure surgical anesthesia to a T4 sensory level, which is in fact lower comparing to the doses reported by previous dose-finding studies. 12 We believe that the adjuvant sufentanil may contribute in reducing the dosage of prilocaine in our study. It is well acknowledged that opioids enhance the quality of anesthesia provided by local anesthetics for caesarean delivery.…”

Current Local Anesthetic Applications in Regional Anesthesia

“…These two medications, both xylidine derivatives as well, demonstrate similar potency when compared to lidocaine [9]. With subsequent studies demonstrating a risk for the development of transient neurologic symptoms associated with intrathecal lidocaine administration, it would seem that mepivacaine and prilocaine are currently undergoing further investigation and may serve as alternatives to lidocaine for ambulatory or surgical procedures of short to moderate duration [13][14][15]. The mid-1960s discovery, synthesis, and spinal administration of bupivacaine, an intermediate to long-acting amide local anesthetic, resulted in widespread popular clinical application [16,17].…”