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AMBULATORY ANESTHESIA

Spinal 2-Chloroprocaine: A Dose-Ranging Study and the Effect of Added Epinephrine

From the Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington

Address correspondence to Dr. Kopacz, Department of Anesthesiology, Virginia Mason Clinic, 1100 Ninth Avenue, B2-AN, PO Box 900, Seattle, WA 98111. Address email to anedjk{at}vmmc.org

With the availability of preservative- and antioxidant-free 2-chloroprocaine (2-CP), there may be an acceptable short-acting alternative to lidocaine for spinal anesthesia. We examined the safety, dose-response characteristics, and effects of epinephrine with spinal 2-CP. Six volunteers per group were randomized to receive 30, 45, or 60 mg of spinal 2-CP with and without epinephrine. Intensity and duration of sensory and motor blockade were assessed. When 11 of the 18 volunteers complained of vague, nonspecific flu-like symptoms, breaking of the blind revealed that all spinal anesthetics associated with the flu-like symptoms contained epinephrine. There were no complaints of flu-like symptoms in the volunteers who received 2-CP without epinephrine. No further spinal anesthetics containing epinephrine were administered, resulting in 29 anesthetics (11 with epinephrine, 18 without epinephrine.) Plain 2-CP demonstrated a dose-dependent increase in peak block height and duration of effect at all variables except time to 2-segment regression and time to regression to T10. Time to complete sensory regression with plain 2-CP was 98 ± 20, 116 ± 15, and 132 ± 23 min, respectively. 2-CP with epinephrine produced times to complete sensory regression of 153 ± 25, 162 ± 33, and 148 ± 29 min, respectively. Preservative and antioxidant free 2-CP can be used effectively for spinal anesthesia in doses of 30–60 mg. Epinephrine is not recommended as an adjunct because of the frequent incidence of side effects.

IMPLICATIONS: Hyperbaric spinal 2-chloroprocaine is effective and has an anesthetic profile appropriate for use in the surgical outpatient over the dose range of 30–60 mg without signs of transient neurologic symptoms. The addition of epinephrine is not recommended because of the frequent incidence of side effects.

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