Chloroprocaine versus prilocaine for spinal anesthesia in ambulatory knee arthroscopy: a double-blind randomized trial

2019 ◽  
Vol 44 (10) ◽  
pp. 944-949
Author(s):  
Elsbeth Wesselink ◽  
Godelief Janssen-van den Hurk ◽  
Rien van der Vegt ◽  
Cornelis Slagt ◽  
Jan van der Aa ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Spinal Anesthesia ◽  
Hospital Discharge ◽  
Knee Arthroscopy ◽  
Sensory Block ◽  
Complete Recovery ◽  
Rapid Onset ◽  
Motor Blockade ◽  
Urine Retention ◽  
Double Blind

BackgroundIn ambulatory lower limb surgery, spinal anesthesia with rapid onset and a short duration of block is preferable. We hypothesized that the use of 2-chloroprocaine would be associated with a faster motor block recovery compared with prilocaine in knee arthroscopy. A difference of 15 min was considered clinically relevant.Methods150 patients were randomly allocated to receive intrathecally either 40 mg of 2-chloroprocaine or 40 mg of prilocaine. The primary outcome was the time to complete recovery from motor blockade. Secondary outcomes included time to full regression of sensory block, peak sensory block level, urine retention needing catheterization, time until hospital discharge, incidence of transient neurologic symptoms and patient satisfaction.ResultsTime to complete recovery from motor blockade was 15 min shorter for 2-chloroprocaine (median: 60 min; IQR: 60–82.5) than for prilocaine (median: 75 min; IQR: 60–90; p=0.004). 2-Chloroprocaine also resulted in faster full regression of sensory block (median: 120 min; IQR: 90–135 compared with median: 165 min; IQR: 135–190, p<0.001) and faster time to hospital discharge (mean difference: 57 min; 95% CI 38 to 77, p<0.001). Peak sensory block was higher in the 2-chloroprocaine group (median: T9; IQR: T6–T12 compared with median: T10; IQR: T8–T12, p<0.008). Patient satisfaction and urine retention needing catheterization were equal in both groups.ConclusionsIn knee arthroscopy, spinal anesthesia with 2-chloroprocaine results in a faster recovery of motor and sensory block, leading to quicker hospital discharge compared with prilocaine.Trial registration numberNTR6796.

ED90 of spinal 2-chloroprocaine 1% in ambulatory knee arthroscopy up to 45 min: a randomized biased-coin- up-and-down sequential allocation trial

2022 ◽  
pp. rapm-2021-103089
Author(s):  
Elsbeth J Wesselink ◽  
Seppe J Koopman ◽  
Rien van der Vegt ◽  
Peter M van de Ven ◽  
Jan P van der Aa ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Knee Arthroscopy ◽  
Final Analysis ◽  
Sensory Block ◽  
Complete Recovery ◽  
Open Label ◽  
Urine Retention ◽  
Quick Recovery ◽  
Smooth Flow ◽  
Biased Coin

BackgroundA short acting spinal anesthetic facilitates smooth flow since quick recovery of motor function will facilitate unassisted ambulation. The aim of this study was to estimate the effective dose (ED90) of intrathecal 2-chloroprocaine 1% in outpatient knee arthroscopy.MethodsTwo cohorts were included in two different hospitals. In cohort I, a randomized biased-coin up-and-down design with 40 patients was used to find the ED90. Four dose-levels of plain 2-chloroprocaine 1% were used: 25, 30, 35 and 40 mg. The identified primary outcome, the ED90, was validated in 50 patients in cohort II with an open label design. Secondary outcomes included time to complete recovery from motor and sensory block with spinal injection as time zero, peak sensory block level, urine retention and time until hospital discharge.ResultsForty patients were included in the final analysis in cohort I. The ED90 was estimated at 27.8 mg, successful spinal anesthesia was obtained in 38 patients (95%). Fifty patients were included in the final analysis in cohort II, 49 patients had successful anesthesia with a fixed round dose of 28 mg. In this Cohort, peak sensory block was T10/T11 (range: (L4–T4)). The median time to full recovery of the motor block was 60 min (45–60) and 90 min (75–105) for the sensory block. The mean time to hospital discharge was 2.9 hours (0.7).ConclusionThe ED90 of 2-chloroprocaine 1% in knee arthroscopy was estimated to be 27.8 mg. In an external population, the ED90 resulted in successful anesthesia in 98% of the patients (95% CI 89% to 100%).Trial registration numberNetherlands Trial Registry (NL6769).

scholarly journals Spinal Anesthesia for Knee Arthroscopy Using Isobaric Bupivacaine and Levobupivacaine: Anesthetic and Neuroophthalmological Assessment

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Monica del-Rio-Vellosillo ◽  
Jose Javier Garcia-Medina ◽  
Antonio Abengochea-Cotaina ◽  
Maria Dolores Pinazo-Duran ◽  
Manuel Barbera-Alacreu
Keyword(s):  
Spinal Anesthesia ◽  
Knee Arthroscopy ◽  
Demographic Data ◽  
Randomized Study ◽  
Sensory Block ◽  
Motor Blockade ◽  
Double Blind ◽  
Sensory Blockade ◽  
Sensory Motor ◽  
Surgeon Satisfaction

Introduction.The aim of the study was to compare the sensory, motor, and neuroophthalmological effects of isobaric levobupivacaine and bupivacaine when intrathecally administered.Materials and Methods.A prospective, double-blind, randomized study with 60 ASA grade I-II patients aged 18–65 years awaiting knee arthroscopy under spinal anesthesia. Patients received 12.5 mg of isobaric bupivacaine or levobupivacaine. Several features were recorded.Results.No significant intergroup differences were observed for ASA classification, time to micturate, demographic data, surgery duration, and patient/surgeon satisfaction. Similar hemodynamic parameters and sensory/motor blockade duration were found for both groups. There were no neuroophthalmological effects in either group. Sensory (P=0.018) and motor blockade onset (P=0.003) was faster in the bupivacaine group. T6 (T2–T12) and T3 (T2–T12) were the highest sensory block levels for the levobupivacaine and bupivacaine groups, respectively (P=0.008). It took less time to regain maximum motor blockade in the bupivacaine group (P=0.014), and the levobupivacaine group required use of analgesia earlier (P=0.025).Conclusions.Isobaric bupivacaine and levobupivacaine are analogous and well-tolerated anesthetics for knee arthroscopy. However, for bupivacaine, sensory and motor blockade onset was faster, and greater sensory blockade with a longer postoperative painless period was achieved.

scholarly journals INTRATHECAL 1% 2 CHLOROPROCAINE V/S 0.5% HYPERBARIC BUPIVACAINE IN AMBULATORY SURGERY

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Mukesh Choudhary ◽  
Abhimanyu Singh
Keyword(s):  
Spinal Anesthesia ◽  
Hospital Discharge ◽  
Ambulatory Surgery ◽  
Sensory Block ◽  
Ambulatory Setting ◽  
Interventional Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Subarachnoid Block

Background: Aims of the study to compare 2-CP with bupivacaine for spinal anesthesia in an elective ambulatory setting. Methods: Hospital based Randomized, Double Blind, Interventional study conducted on patients undergoing for ambulatory surgery under subarachnoid block. Results: The finding that shows the most significant advantage is the time for regression of the sensory block to S2, as 2-CP was faster than bupivacaine. Conclusion: 2-chloroprocaine provides adequate duration and depth of surgical anesthesia for short procedures with the advantages of faster block resolution and earlier hospital discharge compared with spinal bupivacaine Keywords: 2-chloroprocaine, Bupivacaine, Ambulatory surgery

scholarly journals Intrathecal chloroprocaine or hyperbaric prilocaine for ambulatory knee surgery? A prospective randomized study

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
E Guntz ◽  
C Vasseur ◽  
D Ifrim ◽  
A Louvard ◽  
J F Fils ◽  
...  
Keyword(s):  
Side Effects ◽  
Knee Arthroscopy ◽  
Randomized Study ◽  
Sensory Block ◽  
Double Blind Study ◽  
Double Blind ◽  
Number Of Patients ◽  
Prolonged Duration ◽  
Registration Number ◽  
Dermatomal Level

Abstract Purpose The aim of this study was to compare intrathecal 1% chloroprocaine with 2% hyperbaric prilocaine in the setting of ambulatory knee arthroscopy. We hypothesized that complete resolution of the sensory block was faster with chloroprocaine. Methods Eighty patients scheduled for knee arthroscopy were included in this prospective randomized double-blind study. Spinal anesthesia was performed with either chloroprocaine (50 mg) or hyperbaric prilocaine (50 mg). Characteristics of sensory and motor blocks and side effects were recorded. Results Mean time to full sensory block recovery was shorter with chloroprocaine (169 (56.1) min vs 248 (59.4)). The characteristics of the sensory blocks were similar at the T12 dermatome level between the two groups. Differences appeared at T10: the percentage of patients with a sensory block was higher, onset quicker and duration longer with hyperbaric prilocaine. The number of patients with a sensory block at T4 dermatome level in both groups was minimal. Times to full motor recovery were identical in both groups (85 (70–99) vs 86 (76–111) min). Time to spontaneous voiding was shorter with chloroprocaine (203 (57.6) min vs 287.3 (47.2) min). Incidence of side effects was low in both groups. Conclusions When considering the characteristics of the sensory block, the use of chloroprocaine may allow an earlier discharge of patients. Cephalic extension was to a higher dermatomal level and the sensory block at T10 level was of prolonged duration with hyperbaric prilocaine, suggesting that the choice between the two drugs should also be performed based on the level of the sensory block requested by the surgery. This study is registered in the US National Clinical Trials Registry, registration number: NCT030389, the first of February 2017, Retrospectively registered.

The Recovery Profile of Hyperbaric Spinal Anesthesia With Lidocaine, Tetracaine, and Bupivacaine

1998 ◽  
Vol 23 (2) ◽  
pp. 159-163 ◽  
Author(s):  
Kere Frey ◽  
Stephen Holman ◽  
Marianne Mikat-Stevens ◽  
John Vazquez ◽  
Lee White ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Local Anesthetics ◽  
Complete Resolution ◽  
Random Order ◽  
Complete Recovery ◽  
Radicular Pain ◽  
Complete Regression ◽  
Ambulatory Anesthesia ◽  
Double Blind ◽  
Recovery Profile

Background and ObjectivesSurgical procedures previously considered too lengthy for the ambulatory surgery setting are now being performed during spinal anesthesia. The complete recovery profile of tetracaine and bupivacaine are now of interest but are not available in the literature. This study was conducted to compare times to ambulation, voiding, and complete block resolution, as well as the incidence of back and radicular pain, after spinal anesthesia with lidocaine, bupivacaine, and tetracaine.MethodsTwelve adult volunteers underwent spinal anesthesia on three separate occasions with three local anesthetics (lidocaine 100 mg, bupivacaine 15 mg, and tetracaine 15 mg in hyperbaric solutions) in random order and in a double-blind fashion. A 24-gauge Sprotte spinal needle was placed at the L2-3 interspace. The level of analgesia to pinprick was determined moving cephalad in the midclavicular line until a dermatome was reached at which the prick felt as sharp as over an unblocked dermatome. One dermatome caudad to this point was recorded every 5 minutes as the level of analgesia. We also recorded the times to voiding, unassisted ambulation, and complete resolution of sacral anesthesia.ResultsThere was no difference between tetracaine and bupivacaine in time taken for two- and four-segment regression of the analgesia level. However, times to ambulation and complete resolution of the block were significantly shorter with bupivacaine then with tetracaine. With lidocaine, times to four-segment regression, ambulation, voiding, and complete regression of the block were significantly shorter than with bupivacaine and tetracaine. Time to two-segment regression did not differ among local anesthetics. Back and radicular pain symptoms were reported by three subjects after lidocaine subarachnoid block but not after tetracaine or bupivacaine.ConclusionAmong individual subjects, lidocaine exhibited the shortest recovery profile. However, the recovery profiles of the three anesthetics were very variable between subjects. Time to meeting discharge criteria after bupivacaine or tetracaine was faster in a few subjects than that after lidocaine in other subjects. For ambulatory anesthesia, times to two- and four-segment regression do not accurately predict time to readiness for discharge after spinal anesthesia.

scholarly journals High-Volume Spinal Anaesthesia. A Dose-Response Study of Bupivacaine 0.125%

1992 ◽  
Vol 20 (4) ◽  
pp. 443-447 ◽  
Author(s):  
D. H. B. Tay ◽  
S. M. Tay ◽  
E. Thomas
Keyword(s):  
Spinal Anaesthesia ◽  
High Volume ◽  
Sensory Block ◽  
Complete Recovery ◽  
Sensory Level ◽  
Clinical Effects ◽  
Motor Blockade ◽  
Group A ◽  
Group B ◽  
Dose Response Study

The clinical effects of high-volume spinal anaesthesia with bupivacaine 0.125% were studied in 30 patients presenting for postpartum sterilisation. Group A, B and C patients received 6, 8 and 10 ml of bupivacaine 0.125% respectively. Onset, duration and regression of sensory block and motor blockade, haemodynamic parameters and postoperative complications were studied. A sensory level of T10 was reliably obtained in Group B and C but not in Group A. Similarly motor blockade was unreliable in Group A compared with Group B (P < 0.05) and Group C (P < 0.05). Two segment regression times were similar in all three groups. L1 regression times were 4 7.9, 94.3 and 99.0 minutes in Groups A, B and C respectively. The corresponding times for complete recovery of motor power were 120, 212.3 and 182.7 minutes respectively (P < 0.01 when Group A compared to B and C). A significant incidence of high spinal anaesthesia occurred when 10 ml bupivacaine 0.125% was administered (P < 0.05 when compared with Group A). No patient experienced respiratory discomfort in spite of sensory levels of up to T1. Hypotension responded readily to intravenous fluids and small doses of ephedrine (three patients). Only one patient (Group A) developed a postdural puncture headache. In this study, high-volume spinal anaesthesia with bupivacaine 0.125% was found to be satisfactory for postpartum tubal ligation. The optimal volume of bupivacaine 0.125% was 8 ml.

scholarly journals Comparison of dexmedetomidine and buprenorphine as an adjuvant to bupivacaine during spinal anaesthesia for tibial interlocking nailing surgeries

2017 ◽  
Vol 4 (6) ◽  
pp. 1653
Author(s):  
Amitha S. ◽  
Pradeep R.
Keyword(s):  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Motor Blockade ◽  
Hyperbaric Bupivacaine ◽  
Chi Square ◽  
Double Blind ◽  
Sensory Blockade ◽  
Exact Test ◽  
Interlocking Nailing ◽  
Group 3

Background: Buprenorphine is being used as an adjuvant to local anaesthetic for spinal anaesthesia since long. Dexmedetomidine is a new drug which has got alpha 2 agonistic property, and is being tried for spinal anesthesia along with bupivacaine in recent times. Settings and Design: This study was conducted in a prospective, randomized, controlled and double-blind manner. The study included ninety American Society of Anaesthesiologists class I and II patients undergoing tibial interlocking nailing surgeries under spinal anaesthesia.Methods: The patients were randomly divided into three groups (n=30 each) by closed envelope technique. Patients in group 1 received 15 mg of 0.5% hyperbaric bupivacaine, group 2 received 15 mg of 0.5% hyperbaric bupivacaine with 30μg of buprenorphine, and group 3 received 15 mg of 0.5% hyperbaric bupivacaine with 5μg dexmedetomidine for spinal anesthesia. The duration of motor and sensory blockade and any adverse events were recorded. Data were analysed using Chi-square test or Fisher’s exact test for categorical data and analysis of variance for continuous data. A value of P<0.05 was considered as statistically significant.Results: In our study the subjects in group 3 (dexmedetomidine) group had significantly longer period of motor blockade (240±20min) and sensory blockade (180±22.2min) compared to other groups, which is statistically significant (P=0.0001 and P= 0.006 respectively). The time to first request of analgesic in the post-operative period was also longer (240±30.2min) in dexmedetomidine group when compared with other groups (P=0.0001). There were no untoward complications (hypotension, sedation) in any groups.Conclusions: We concluded that dexmedetomidine (5μg) with bupivacaine for spinal anesthesia gives significantly longer duration of sensory and motor blockade, than buprenorphine (30μg) with bupivacaine for spinal anaesthesia.

scholarly journals Isobaric levobupivacaine a better and safer substitute for spinal anaesthesia in patients undergoing prolonged lower abdominal and lower limb surgeries

2018 ◽  
Vol 6 (9) ◽  
pp. 3111
Author(s):  
Wasimul Hoda ◽  
Abhishek Kumar ◽  
Priodarshi Roychoudhury
Keyword(s):  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Lower Limb ◽  
Motor Block ◽  
Sensory Block ◽  
Double Blind Study ◽  
Double Blind ◽  
Sensory Blockade ◽  
Group A ◽  
Group B

Background: Bupivacaine being the drug of choice for spinal anaesthesia is associated with serious cardiac toxicity. Levobupivacaine and ropivacaine, both being the two S enantiomers of bupivacaine can be a safer alternatives with better cardiovascular safety. Hence, the clinical efficacy of both were assessed and compared in patients undergoing spinal anesthesia.Methods: A prospective randomized controlled double blind study was done in 68 adult posted for elective lower abdominal and lower limb surgeries under spinal anesthesia. They were randomized into 2 groups. About 3ml isobaric levobupivacaine 0.5% (15mg) was given in group A and 3ml isobaric ropivacaine 0.5% (15mg) was given in group B. Onset, duration of sensory and motor blocks, time for maximum sensory and motor block, time for 2 segment sensory regression and haemodynamic parameters were recorded and analyzed.Results: All patients achieved a sensory block of T10 dermatome. Onset of sensory blockade at T10 was similar in both groups, group A (5.71±1.31min) and group B (5.94±1.72min). Time from injection to two dermatomal regression was 129.68±15.54min in group A and 111.38±22.35min in group B. Onset of Bromage score of 1 in group A was 4.68±1.27min and in group B was 6.44±1.64min. The mean duration of motor and complete motor block was prolonged in group A patients (197.74±18.51min, 168.82±17.90 min) as compared to group B (131.88±20.41min, 106.71±10.85min).Conclusions: Isobaric levobupivacaine was found to be a better and safer substitute for spinal anesthesia in patients undergoing prolonged lower abdominal and lower limb surgeries.

scholarly journals Effect of 3 Different Doses of Intrathecal Dexmedetomidine (2.5µg, 5µg, and 10 µg) on Subarachnoid Block Characteristics: A Prospective Randomized Double Blind DoseResponse Trial

2016 ◽  
Vol 3;19 (3;3) ◽  
pp. E411-E420 ◽  
Author(s):  
Dr Mayank Gupta
Keyword(s):  
Adverse Effects ◽  
Motor Block ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
College Teaching ◽  
Sensory Block ◽  
Motor Blockade ◽  
Analgesic Requirement ◽  
Double Blind ◽  
Subarachnoid Block

Background: The extended analgesic efficacy of intrathecal dexmedetomidine (ITD) has been investigated in a few clinical trials; however, there is a lack of conclusive evidence upon its ideal dosage. Objectives: To elucidate the dose-response relationship between ITD and subarachnoid block characteristics, particularly the duration of analgesia and differential analgesia (DA: defined as time difference from the offset of motor blockade to the first analgesic requirement on numerical rating scale ≥ 4.0). Study Design: Prospective, randomized double blind active control trial. Setting: Medical college teaching hospital. Methods: Ninety adult (18 – 60 years) patients undergoing elective lower abdominal and lower limb surgeries were randomized into 3 groups to receive intrathecal 0.5% bupivacaine 3 mL with 2.5 µg (group BD2.5), 5µg (group BD5), or 10 µg (group BD10) dexmedetomidine in 0.5 mL normal saline. The 2 segment sensory regression times (TSSRT), duration of motor blockade analgesia, DA, and perioperative adverse effects were assessed. The primary outcome was duration of analgesia and DA. Statistics: ANOVA, Kruskal Wallis test, Chi-square (χ2), and Fisher’s exact test, significance: P < 0.05. Results: The onset of sensory block was significantly earlier in group BD10 compared with group BD5 (P = 0.035) and BD2.5 (P = 0.010) while the onset of motor block was significantly earlier in group BD10 compared with BD2.5 (P = 0.020). There was a significant and dose-dependent prolongation of the duration of sensory block (127.50, 149.17, and 187.50 minutes; P < 0.001), motor block (258.50, 331, and 365 minutes; P < 0.001), analgesia (306.17, 396.50, and 512 minutes; P < 0.001), and DA (47.67, 65.50, and147 minutes; P < 0.001) with escalating doses of ITD, respectively. Group BD10 required significantly fewer rescue analgesics compared with other 2 groups (P = 0.001). Except for mild sedation which was significantly higher in group BD10; all the groups were comparable with respect to hemodynamic and other adverse effects. Limitations: Lack of placebo group, exclusion of higher doses (15µg) of ITD, and short duration of postoperative follow-up. Conclusions: The addition of 10 µg compared with 2.5 µg or 5µg ITD to 0.5% hyperbaric bupivacaine is associated with significantly earlier onset of sensory and motor block as well as prolonged duration of sensory block, motor block, analgesia, and DA with a comparable adverse effect profile. Key words: Analgesia, bupivacaine, dexmedetomidine, differential analgesia, intrathecal, pain, spinal anaesthesia

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