Non-alkalinized and alkalinized 2-chloroprocaine vs lidocaine for intravenous regional anesthesia during outpatient hand surgery.
OBJECTIVE
Chloroprocaine should be an ideal agent for intravenous regional anesthesia (IVRA) because of its rapid onset and ester hydrolysis. Raising the pH of local anesthetics may increase the speed of onset and the intensity of nerve blocks. We compared plain and alkalinized 2-chloroprocaine 0.5% with lidocaine for IVRA.


METHODS
In two separate double-blind studies, 78 patients scheduled for daycare hand surgery were randomized to receive 40 mL plain 2-chloroprocaine 0.5%, alkalinized 2-chloroprocaine 0.5% or lidocaine 0.5% for IVRA. Time to sensory and motor block, need for supplemental analgesia, and side effects were compared.


RESULTS
There was no difference in time to sensory or motor block in either group. Patients who received plain chloroprocaine required more supplemental opioid and had a higher incidence of metallic taste and of hives than patients who received lidocaine (P < 0.05). Comparing alkalinized chloroprocaine with lidocaine, there was no difference found with respect to opioid supplementation, CNS side effects, or incidence of hives.


CONCLUSIONS
In conclusion, alkalinized chloroprocaine was found to be an effective agent for IVRA but no benefit over lidocaine was detected. Plain chloroprocaine for IVRA produced more minor side effects than lidocaine.
Lavin
P A
PA
Department of Anesthesia, Vancouver General Hospital, University of British Columbia, Canada.
Henderson
C L
CL
Vaghadia
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D000765:Anesthesia, Conduction / Q000009:adverse effects; D000771:Anesthesia, Intravenous / Q000009:adverse effects; D000779:Anesthetics, Local / Q000009:adverse effects / Q000737:chemistry; D004311:Double-Blind Method; D005260:Female; D006225:Hand / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008012:Lidocaine / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011343:Procaine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000737:chemistry; D011446:Prospective Studies
D000779:Anesthetics, Local; D011343:Procaine; C004616:chloroprocaine; D008012:Lidocaine