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REGIONAL ANESTHESIA

Intrathecal 2-Chloroprocaine for Lower Limb Outpatient Surgery: A Prospective, Randomized, Double-Blind, Clinical Evaluation

From the University of Parma, Department of Anesthesia and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy.

Address correspondence and reprint requests to Andrea Casati, MD, Department of Anesthesiology, Azienda Ospedaliera di Parma, Via Gramsci 14 – 43100 Parma, Italy. Address e-mail to acasati{at}ao.pr.it.

We evaluated the dose-response relationship of 2-chloroprocaine for lower limb outpatient procedure in 45 ASA physical status I-II outpatients undergoing elective lower limb surgery under spinal anesthesia, with 30 mg (group Chlor-30, n = 15), 40 mg (group Chlor-40, n = 15), or 50 mg (group Chlor-50, n = 15) of 1% preservative free 2-chloroprocaine. Onset time was similar in the three groups. General anesthesia was never required to complete surgery. Intraoperative analgesic supplementation as a result of insufficient duration of spinal block was required in 5 patients of group Chlor-30 (35%) and 2 patients of group Chlor-40 (13%) (P = 0.014), with a median (range) time for supplementation request of 40 (30–60) min. Spinal block resolution and recovery of ambulation were faster in group Chlor-30 (60 [41–98] min and 85 [45–123] min) than in groups Chlor-40 (85 [46–141] min and 180 [72–281] min) and Chlor-50 (97 [60–169] min and 185 [90–355] min) (P = 0.001 and P = 0.003, respectively), with no differences in home discharge time (182 [120–267] min in group Chlor-30, 198 [123–271] min in group Chlor-40, and 203 [102–394] min in group Chlor-50; P = 0.155). No transient neurologic symptoms were reported at 24-h and 7-day follow-up. We conclude that although 40 and 50 mg of 2-chloroprocaine provide adequate spinal anesthesia for outpatient procedures lasting 45–60 min, 30 mg produces a spinal block of insufficient duration.

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