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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 4/2011

01-04-2011 | Reports of Original Investigations

Comparison of bupivacaine and 2-chloroprocaine for spinal anesthesia for outpatient surgery: a double-blind randomized trial

Authors: Marie-Andrée Lacasse, MD, Jean-Denis Roy, MD, Josée Forget, MD, Franck Vandenbroucke, MD, Robert F. Seal, MD, Danielle Beaulieu, MD, Michael McCormack, MD, Luc Massicotte, MD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 4/2011

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Abstract

Background

We have always been searching for the ideal local anesthetic for outpatient spinal anesthesia. Lidocaine has been associated with a high incidence of transient neurological symptoms, and bupivacaine produces sensory and motor blocks of long duration. Preservative-free 2-chloroprocaine (2-CP) seems to be a promising alternative, being a short-acting agent of increasing popularity in recent years. This study was designed to compare 2-CP with bupivacaine for spinal anesthesia in an elective ambulatory setting.

Methods

A total of 106 patients were enrolled in this randomized double-blind study. Spinal anesthesia was achieved with 0.75% hyperbaric bupivacaine 7.5 mg (n = 53) or 2% preservative-free 2-CP 40 mg (n = 53). The primary endpoint for the study was the time until reaching eligibility for discharge. Secondary outcomes included the duration of the sensory and motor blocks, the length of stay in the postanesthesia care unit, the time until ambulation, and the time until micturition.

Results

The average time to discharge readiness was 277 min in the 2-CP group and 353 min in the bupivacaine group, a difference of 76 min (95% confidence interval [CI]: 40 to 112 min; P < 0.001). The average time for complete regression of the sensory block was 146 min in the 2-CP group and 329 min in the bupivacaine group, a difference of 185 min (95% CI: 159 to 212 min; P < 0.001). Times to ambulation and micturition were also significantly lower in the 2-CP group.

Conclusion

Spinal 2-chloroprocaine provides adequate duration and depth of surgical anesthesia for short procedures with the advantages of faster block resolution and earlier hospital discharge compared with spinal bupivacaine. (ClinicalTrials.gov number, NCT00845962).
Literature
1.
2.
3.
Freedman JM, Li DK, Drasner K, Jaskela MC, Larsen B, Wi S. Transient neurologic symptoms after spinal anesthesia: an epidemiologic study of 1,863 patients. Anesthesiology 1998; 89: 633-41.PubMedCrossRef
4.
Zaric D, Christiansen C, Pace NL, Punjasawadwong Y. Transient neurologic symptoms after spinal anesthesia with lidocaine versus other local anesthetics: a systematic review of randomized, controlled trials. Anesth Analg 2005; 100: 1811-6.PubMedCrossRef
5.
Schneider M, Ettlin T, Kaufmann M, et al. Transient neurologic toxicity after hyperbaric subarachnoid anesthesia with 5% lidocaine. Anesth Analg 1993; 76: 1154-7.PubMedCrossRef
6.
Hampl KF, Schneider MC, Umenhofer W, Drewe J. Transient neurologic symptoms after spinal anesthesia. Anesth Analg 1995; 81: 1148-53.PubMedCrossRef
7.
Pollock JE, Neal JM, Stephenson CA, Wiley CE. Prospective study of the incidence of transient radicular irritation in patients undergoing spinal anesthesia. Anesthesiology 1996; 84: 1361-7.PubMedCrossRef
8.
Liu SS, Ware PD, Allen HW, Neal JM, Pollock JE. Dose-response characteristics of spinal bupivacaine in volunteers: clinical implications for ambulatory anesthesia. Anesthesiology 1996; 85: 729-36.PubMedCrossRef
9.
Ben-David B, Solomon E, Levin H, Admoni H, Goldik Z. Intrathecal fentanyl with small-dose dilute bupivacaine: better anesthesia without prolonging recovery. Anesth Analg 1997; 85: 560-5.PubMedCrossRef
10.
Breebaart MB, Vercauteren MP, Hoffmann VL, Adriaensen HA. Urinary bladder scanning after day-case arthroscopy under spinal anaesthesia: comparison between lidocaine, ropivacaine, and levobupivacaine. Br J Anaesth 2003; 90: 309-13.PubMedCrossRef
11.
Foldes FF, McNall PG. 2-Chloroprocaine: a new local anesthetic agent. Anesthesiology 1952; 13: 287-96.PubMedCrossRef
12.
Anonymous. Chloroprocaine hydrochloride. J Am Med Assoc 1957; 163: 38-9.
13.
Ansbro FP, Blundell AE, Bodell B, Pillion JW. Nesacaine (2-chloroprocaine): its relative nontoxicity as demonstrated by in vivo studies. Anesth Analg 1960; 39: 7-12.PubMedCrossRef
14.
Krumperman LW, Meschter SC, Close EL, Wester MR, Erickson JC, Strenge HJ. Transdural diffusion of 2-chloroprocaine hydrochloride in man. Anesth Analg 1960; 39: 55-8.PubMedCrossRef
15.
Barsa J, Batra M, Fink BR, Sumi SM. A comparative in vivo study of local neurotoxicity of lidocaine, bupivacaine, 2-chloroprocaine, and a mixture of 2-chloroprocaine and bupivacaine. Anesth Analg 1982; 61: 961-7.PubMed
16.
17.
Rosen MA, Baysinger CL, Shnider SM, et al. Evaluation of neurotoxicity after subarachnoid injection of large volumes of local anesthetic solutions. Anesth Analg 1983; 62: 802-8.PubMed
18.
Ready LB, Plumer MH, Haschke RH, Austin E, Sumi SM. Neurotoxicity of intrathecal local anesthetics in rabbits. Anesthesiology 1985; 63: 364-70.PubMedCrossRef
19.
Myers RR, Kalichman MW, Reisner LS, Powell HC. Neurotoxicity of local anesthetics: altered perineurial permeability, edema, and nerve fiber injury. Anesthesiology 1986; 64: 29-35.PubMedCrossRef
20.
Covino BG. Toxicity of local anesthetic agents. Acta Anaesthesiol Belg 1988; 39: 159-64.PubMed
21.
Kalichman MW, Moorhouse DF, Powell HC, Myers RR. Relative neural toxicity of local anesthetics. J Neuropathol Exp Neurol 1993; 52: 234-40.PubMedCrossRef
22.
Riggi SJ. Chloroprocaine: neurotoxicity and formulations in perspective. Anesth Analg 1982; 61: 715-7.PubMedCrossRef
23.
Wang BC, Hillman DE, Spielholz NI, Turndorf H. Chronic neurological deficits and Nesacaine-CE: an effect of the anesthetic, 2-chloroprocaine, or the antioxidant, sodium bisulfite? Anesth Analg 1984; 63: 445-7.PubMedCrossRef
24.
Kalichman MW, Powell HC, Reisner LS, Myers RR. The role of 2-chloroprocaine and sodium bisulfite in rat sciatic nerve edema. J Neuropathol Exp Neurol 1986; 45: 566-75.PubMedCrossRef
25.
Ford DJ, Raj PP. Peripheral neurotoxicity of 2-chloroprocaine and bisulfite in the cat. Anesth Analg 1987; 66: 719-22.PubMedCrossRef
26.
Seravalli E, Lear E. Toxicity of chloroprocaine and sodium bisulfite on human neuroblastoma cells. Anesth Analg 1987; 66: 954-8.PubMedCrossRef
27.
Hersh EV, Condouris GA, Havelin D. Actions of intrathecal chloroprocaine and sodium bisulfite on rat spinal reflex function utilising a noninvasive technique. Anesthesiology 1990; 72: 1077-82.PubMedCrossRef
28.
Anonymous. Prolonged neural blockade following regional analgesia with 2-chloroprocaine. Anesth Analg 1980; 59: 810-1.
29.
Anonymous. Chloroprocaine labelling revised. FDA Drug Bull 1980; 10: 23-4.
30.
Kane RE. Neurologic deficits following epidural or spinal anesthesia. Anesth Analg 1981; 60: 150-61.PubMedCrossRef
31.
32.
de Jong RH. The chloroprocaine controversy. Am J Obstet Gynecol 1981; 140: 237-9.PubMed
33.
Moore DC. Local anesthetic drugs: tissue and systemic toxicity. Acta Anaesthesiol Belg 1981; 32: 283-300.PubMed
34.
Moore DC, Spierdijk J, van Kleef JD, Coleman RL, Love GF. Chloroprocaine neurotoxicity: four additional cases. Anesth Analg 1982; 61: 155-9.PubMed
35.
Ravindran RS, Turner MS, Muller J. Neurologic effects of subarachnoid administration of 2-chloroprocaine-CE, bupivacaine, and low pH normal saline in dogs. Anesth Analg 1982; 61: 279-83.PubMed
36.
Li DF, Bahar M, Cole G, Rosen M. Neurological toxicity of the subarachnoid infusion of bupivacaine, lidocaine or 2-chloroprocaine in the rat. Br J Anaesth 1985; 57: 424-9.PubMedCrossRef
37.
38.
Kouri ME, Kopacz DJ. Spinal 2-chloroprocaine: a comparison with lidocaine in volunteers. Anesth Analg 2004; 98: 75-80.PubMedCrossRef
39.
Smith KN, Kopacz DJ, McDonald SB. Spinal 2-chloroprocaine: a dose-ranging study and the effect of added epinephrine. Anesth Analg 2004; 98: 81-8.PubMedCrossRef
40.
Vath JS, Kopacz DJ. Spinal 2-chloroprocaine: the effect of added fentanyl. Anesth Analg 2004; 98: 89-94.PubMedCrossRef
41.
Warren DT, Kopacz DJ. Spinal 2-chloroprocaine: the effect of added dextrose. Anesth Analg 2004; 98: 95-101.PubMedCrossRef
42.
Kopacz DJ. Spinal 2-chloroprocaine: minimum effective dose. Reg Anesth Pain Med 2005; 30: 36-42.PubMed
43.
Davis BR, Kopacz DJ. Spinal 2-chloroprocaine: the effect of added clonidine. Anesth Analg 2005; 100: 559-65.PubMedCrossRef
44.
Yoos JR, Kopacz DJ. Spinal 2-chloroprocaine: a comparison with small-dose bupivacaine in volunteers. Anesth Analg 2005; 100: 566-72.PubMedCrossRef
45.
Gonter AF, Kopacz DJ. Spinal 2-chloroprocaine: a comparison with procaine in volunteers. Anesth Analg 2005; 100: 573-9.PubMedCrossRef
46.
Yoos JR, Kopacz DJ. Spinal 2-chloroprocaine for surgery: an initial 10-month experience. Anesth Analg 2005; 100: 553-8.PubMedCrossRef
47.
Casati A, Danelli G, Berti M, et al. Intrathecal 2-chloroprocaine for lower limb outpatient surgery: a prospective, randomized, double-blind, clinical evaluation. Anesth Analg 2006; 103: 234-8.PubMedCrossRef
48.
Casati A, Fanelli G, Danelli G, et al. Spinal anesthesia with lidocaine or preservative-free 2-chloroprocaine for outpatient knee arthroscopy: a prospective, randomized, double-blind comparison. Anesth Analg 2007; 104: 959-64.PubMedCrossRef
49.
Sell A, Tein T, Pitkanen M. Spinal 2-chloroprocaine: effective dose for ambulatory surgery. Acta Anaesthesiol Scand 2008; 52: 695-9.PubMedCrossRef
50.
Fu RQ, Tian YK, Fang WR. Combined spinal and epidural anaesthesia with chloroprocaine for hysterectomy. Clin Exp Pharmacol Physiol 2008; 35: 60-3.PubMedCrossRef
51.
Palas TA. Four years’ experience with 1% chloroprocaine for spinal anesthesia in ambulatory anesthesia. Reg Anesth Pain Med 2005; 30(Suppl 1): 13 (abstract).CrossRef
52.
Hadzic A. Textbook of regional anesthesia and acute pain management. New York: McGraw Hill; 2007. p. 85.
53.
Ben-David B, Levin H, Solomon E, Admoni H, Vaida S. Spinal bupivacaine in ambulatory surgery: the effect of saline dilution. Anesth Analg 1996; 83: 716-20.PubMedCrossRef
54.
Zaric D, Pace NL. Transient neurologic symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics. Cochrane Database Syst Rev 2009; (2): CD003006.
55.
Warner MA, Warner DO, Harper CM, Schroeder DR, Maxson PM. Lower extremity neuropathies associated with lithotomy positions. Anesthesiology 2000; 93: 938-42.PubMedCrossRef
56.
Tondare AS, Nadkarni AV, Sathe CH, Dave VB. Femoral neuropathy: a complication of lithotomy position under spinal anaesthesia. Report of three cases. Can Anaesth Soc J 1983; 30: 84-6.PubMedCrossRef
57.
Boyles SH, Edwards R, Gregory W, Clark A. Complications associated with transobturator sling procedures. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18: 19-22.PubMedCrossRef
Metadata
Title
Comparison of bupivacaine and 2-chloroprocaine for spinal anesthesia for outpatient surgery: a double-blind randomized trial
Authors
Marie-Andrée Lacasse, MD
Jean-Denis Roy, MD
Josée Forget, MD
Franck Vandenbroucke, MD
Robert F. Seal, MD
Danielle Beaulieu, MD
Michael McCormack, MD
Luc Massicotte, MD
Publication date
01-04-2011
Publisher
Springer-Verlag
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 4/2011
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-010-9450-x

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