Using chloroprocaine for spinal anaesthesia in outpatient knee-arthroscopy results in earlier discharge and improved operating room efficiency compared to mepivacaine and prilocaine

Abstract

Purpose Knee arthroscopies are regularly carried out in an outpatient setting. The purpose of this retrospective analysis was to investigate the impact of different local anaesthetics for spinal anaesthesia on operating room efficiency (perioperative process times) and postoperative recovery. This study aims to determine the optimal LA for SPA in patients undergoing knee arthroscopy at a day-surgery centre. Methods Anaesthesia records of all patients undergoing knee arthroscopy under spinal anaesthesia from 2010 until 2017 were analysed. Patients were categorised as having received spinal anaesthesia with prilocaine, mepivacaine or chloroprocaine. Results Three-hundred and nine patients were included. Postoperative recovery was significantly faster for chloroprocaine 1% compared with both other local anaesthetics regarding all stages of recovery until discharge. Perioperative processes and surgery time were significantly shorter when chloroprocaine was used. Early postoperative pain occurred more frequently and earlier after spinal anaesthesia with chloroprocaine. Nevertheless, pain intensity did not differ between groups. Conclusion Spinal anaesthesia provides reliable blocks for outpatient knee arthroscopy. Considerations on the choice of local anaesthetic for spinal anaesthesia must include not only the recovery profile, but also the impact on operating room efficiency. Due to a superior recovery profile, low incidences of adverse side effects and raised operating room efficiency, chloroprocaine is the recommendable local anaesthetic for spinal anaesthesia in patients undergoing knee arthroscopy in an ambulatory setting. Since the frequency of SPA in patients undergoing outpatient knee arthroscopy is rising yearly, the results of this study are of high clinical relevance. The use of chloroprocaine leads to improved recovery, optimized perioperative processes and consecutively to a raised OR efficiency. Level of evidence III.

Spinal Anesthesia Using Chloroprocaine is Safe, Effective, and Facilitates Earlier Discharge in Selected Fast-track Total Hip Arthroplasty

“…In this cohort, chloroprocaine use was associated with increased OR efficiency, as seen by the shorter operative time for patients who received chloroprocaine. These findings mirror those found in knee arthroscopy studies where chloroprocaine was compared with other short-acting local anesthetics [15]. As discussed by Gebhardt et al [15], the shorter operative time in the chloroprocaine cohort may be a reflection of an improved interdisciplinary team effort and increased effort by surgeons to keep operative times as short as possible, as the shorter duration of action of the spinal may inspire surgeons to perform cases more efficiently, with less teaching.…”

“…These findings mirror those found in knee arthroscopy studies where chloroprocaine was compared with other short-acting local anesthetics [15]. As discussed by Gebhardt et al [15], the shorter operative time in the chloroprocaine cohort may be a reflection of an improved interdisciplinary team effort and increased effort by surgeons to keep operative times as short as possible, as the shorter duration of action of the spinal may inspire surgeons to perform cases more efficiently, with less teaching. The shorter operative times may also reflect a lower case complexity in the group selected to receive chloroprocaine, which was not reflected in the comparison of baseline demographics of matched groups.…”

“…One common choice for spinal anesthesia in THA is bupivacaine, a long-acting amino amide local anesthetic that can be associated with prolonged block effects [7] as well as unpredictable anesthetic effects, long duration of action, and hemodynamic instability when given in higher doses [7][8][9][10]. Shorter-acting local amino amides such as lidocaine and mepivacaine are being used, but there have been repeated reports of transient neurologic symptoms (TNSs) by multiple groups [11][12][13][14][15][16] and side effects that are both undesirable and avoidable for these specific medications. Chloroprocaine, an aminoester local anesthetic with a short half-life, has been an efficient choice for anesthesia, in addition to having a superior recovery profile when compared with other short-acting agents [15][16][17][18].…”

“…Shorter-acting local amino amides such as lidocaine and mepivacaine are being used, but there have been repeated reports of transient neurologic symptoms (TNSs) by multiple groups [11][12][13][14][15][16] and side effects that are both undesirable and avoidable for these specific medications. Chloroprocaine, an aminoester local anesthetic with a short half-life, has been an efficient choice for anesthesia, in addition to having a superior recovery profile when compared with other short-acting agents [15][16][17][18]. To date, chloroprocaine's use has been limited to short-duration ambulatory procedures, such as knee arthroscopy, given its short half-life.…”

Impact of Chloroprocaine on the Eligibility for Hospital Discharge in Patients Requiring Ambulatory Surgery Under Spinal Anesthesia: An Observational Multicenter Prospective Study

“…These studies also reported the benefit of spinal chloroprocaine with a faster recovery of patients' autonomy. Data in ambulatory orthopedic surgery suggest that chloroprocaine is a reliable and sufficient anesthesia [11]. Camponovo and colleagues [12] showed that onsets of unassisted ambulation and hospital discharge were significantly faster in patients receiving chloroprocaine compared to patients receiving bupivacaine.…”