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ANALGESIA

Spinal Anesthesia with Lidocaine or Preservative-Free 2-Chlorprocaine for Outpatient Knee Arthroscopy: A Prospective, Randomized, Double-Blind Comparison

Andrea Casati, MD^*, Guido Fanelli, MD^*, Giorgio Danelli, MD^*, Marco Berti, MD^*, Daniela Ghisi, MD^*, Matteo Brivio, MD^*, Marta Putzu, MD^*, and Alessia Barbagallo, MD

*From the University of Parma - Department of Anesthesiology and Pain Therapy, Ospedale Maggiore di Parma - Via Gramsci 14, 43100 Parma, Italy and University of Messina - Department of Anesthesiology.

Address correspondence and reprint requests to Dr. Andrea Casati, Department of Anesthesia and Pain Treatment, University of Parma, Via Gramsci 14, 43100 Parma. Address e-mail to andrea.casati{at}unipr.it.

Abstract

BACKGROUND: In this prospective, randomized, double-blind study we tested the hypothesis that 50 mg of 1% preservative-free 2-chloroprocaine would provide a faster resolution of spinal block than the same dose of 1% plain lidocaine.

METHODS: After IV midazolam premedication (0.03 mg/kg), 30 ASA physical status I–II outpatients undergoing knee arthroscopy were randomly allocated to receive 50 mg of either 1% plain lidocaine (n = 15) or 1% preservative-free plain chloroprocaine (n = 15). A blinded observer recorded the evolution of sensory (loss of pinprick sensation) and motor (modified Bromage scale) block until complete regression, as well as times to unassisted ambulation and voiding. A telephone call follow-up was performed 24 h and 7 days after surgery.

RESULTS: Two chloroprocaine patients (13%) and one lidocaine patient (7%) required fentanyl supplementation (100 µg IV) (P = 0.99) intraoperatively, but no patient required general anesthesia to complete surgery. Median (range) times for recovery of sensory and motor function, and unassisted ambulation were faster with 2-chloroprocaine [95 (68–170) min; 60 (45–120) min; and 103 (70–191) min] than lidocaine [120 (80–175) min; 100 (60–140) min; and 152 (100–185) min] (P = 0.019, P = 0.0005, and P = 0.003, respectively). No differences in first voiding were reported between chloroprocaine [180 (100–354) min] and lidocaine patients [190 (148–340) min] (P = 0.191). Transient neurological symptoms were reported in five lidocaine patients (33%) but no chloroprocaine patients (0%) (P = 0.042).

CONCLUSION: Intrathecal injection of 50 mg of preservative-free 2-chloroprocaine 1% resulted in quicker recovery of sensory/motor function, and unassisted ambulation, and fewer incidences of transient neurologic symptoms than the same dose of 1% lidocaine.

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