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AMBULATORY ANESTHESIA

Spinal 2-Chloroprocaine: The Effect of Added Fentanyl

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

Chloroprocaine is being investigated as a possible replacement for spinal lidocaine. Adding fentanyl to lidocaine increases the quality of spinal anesthesia without prolongation of block. We report the characteristics of 2-chloroprocaine (2-CP) spinal anesthesia with or without fentanyl in 8 volunteers receiving 40 mg 2-CP with saline or 20 µg fentanyl in a double-blinded, randomized, crossover manner. Spinal anesthesia was successful for all subjects with complete block regression, ambulation, and void by 110 min. Itching occurred in all subjects receiving fentanyl, though medication was not required. No subject reported signs of transient neurological symptoms. Peak block with fentanyl averaged T5 (T3–7) and without fentanyl T9 (L1–T4) (P = 0.005). Regression to L1 was 78 ± 7 min with fentanyl and 53 ± 19 min without fentanyl (P = 0.02). Tourniquet was tolerated for 51 ± 8 min with fentanyl and for 34 ± 14 min without fentanyl (P = 0.02). Complete regression of block occurred at 104 ± 7 min with fentanyl and by 95 ± 9 min without fentanyl (P = 0.02). We conclude that 2-CP spinal anesthesia provides rapid onset and adequate potency, giving it a positive profile for ambulatory surgery. The addition of fentanyl lengthens regression to L1 and tourniquet tolerance while minimally lengthening block duration.

IMPLICATIONS: Spinal 2-chloroprocaine (40 mg) provides rapid onset and reliable blockade without signs of transient neurological symptoms, giving it a positive profile for ambulatory surgical settings. The addition of fentanyl appears to lengthen the regression to L1 dermatome and tourniquet time while minimally lengthening duration of block.

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