Hospital discharge after ambulatory knee arthroscopy: A comparison of epidural 2-chloroprocaine versus lidocaine.
OBJECTIVE
This prospective, randomized, double-blind study compares the efficacy of epidural 2-chloroprocaine and lidocaine for attaining hospital discharge criteria after ambulatory knee arthroscopy. We hypothesized that 2-chloroprocaine would facilitate earlier discharge than lidocaine.


METHODS
American Society of Anesthesiologists (ASA) I and II patients were randomized to receive equipotent doses of epidural 3% 2-chloroprocaine or 1.5% lidocaine, both without epinephrine. Time to block resolution and discharge were compared between groups, along with the need for epidural reinjection, surgical times, and postoperative back pain.


RESULTS
Twenty-seven patients completed the study, 13 in the 2-chloroprocaine group and 14 in the lidocaine group. The 2-chloroprocaine group was ready for discharge significantly earlier than the lidocaine group (130 +/- 17 min [range, 105 to 160] v 191 +/- 32 min [range 144 to 251]; P <.0001, 90% power). The lidocaine group required more epidural reinjections. Anesthesia-related side effects were similar in both groups.


CONCLUSIONS
Epidural 3% 2-chloroprocaine without epinephrine is an advantageous choice for ambulatory knee arthroscopy. It enables readiness for discharge an hour sooner than 1.5% lidocaine, requires fewer reinjection interventions, and may reduce delayed discharge secondary to prolonged time to void. This clinical study shows the superiority of epidural 3% 2-chloroprocaine over 1.5% lidocaine for expediting hospital discharge after ambulatory surgery.
Neal
J M
JM
Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA. anejmn@vmmc.org
Deck
J J
JJ
Kopacz
D J
DJ
Lewis
M A
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D001182:Arthroscopy / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D007719:Knee Joint / Q000601:surgery*; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D008136:Longevity; D008297:Male; D008875:Middle Aged; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced / Q000209:etiology; D011343:Procaine / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives*; D011446:Prospective Studies
D000779:Anesthetics, Local; D011343:Procaine; C004616:chloroprocaine; D008012:Lidocaine