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ANALGESIA

A Randomized, Prospective, Double-Blind Trial Comparing 3% Chloroprocaine Followed by 0.5% Bupivacaine to 2% Lidocaine Followed by 0.5% Bupivacaine for Interscalene Brachial Plexus Block

From the Department of Anesthesiology, New York Methodist Hospital, Brooklyn, New York.

Address correspondence and reprint requests to Soheila Jafari, Department of Anesthesiology, New York Methodist Hospital, 506 Sixth St., Brooklyn, NY 11215. Address e-mail to s1jafari{at}aol.com or s1jafari{at}aim.com.

Abstract

BACKGROUND: The combination of 2-chloroprocaine and bupivacaine (C/B) for regional anesthesia has been described, but its use was largely abandoned due to equivocal results in efficacy. In this prospective, double-blind, randomized study, we compared the onset of an interscalene block using C/B versus a combination of lidocaine and bupivacaine (L/B).

METHODS: Thirty patients scheduled for shoulder arthroscopy under interscalene block were divided into two groups of 15 each. One group (C/B) received 3% 2-chloroprocaine combined with bicarbonate and epinephrine, immediately followed by 0.5% bupivacaine and epinephrine, whereas the other group (L/B) received 2% lidocaine instead of 3% 2-chloroprocaine. Motor and sensory block were assessed every 15 s. The primary end-point was the time of onset to complete motor block. Time-to-event (survival) statistical analysis tests were applied.

RESULTS: One L/B patient had a failed block, and was excluded. The median time to motor block for C/B and L/B was 90 (15–575) and 180 (15–3720) s, respectively (P = 0.0325), and to sensory block for C/B and L/B was 90 (30–600) and 210 (30–3900) s, respectively (P = 0.0185). Survival analysis showed that in 5 min, 13 of 15 patients from the C/B group but only 7 of 14 from the L/B group had a successful motor block. In 10 min, 15 of 15 patients from the C/B group but only 10 of 14 from the L/B group had a successful motor block. It took as long as 60 min to assess block success/failure for blocks in the L/B group.

CONCLUSIONS: This study demonstrates that a successful block was more rapid using C/B than L/B for interscalene blocks.