Spinal 2-chloroprocaine: the effect of added fentanyl.
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 micro g 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.


CONCLUSIONS
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.
Vath
Julie S
JS
From the Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington.
Kopacz
Dan J
DJ
D000759:Adjuvants, Anesthesia; D000328:Adult; D000556:Ambulatory Surgical Procedures; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000009:adverse effects; D004311:Double-Blind Method; D004558:Electric Stimulation; D004576:Electromyography; D005260:Female; D005283:Fentanyl; D006801:Humans; D008012:Lidocaine / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons / Q000187:drug effects; D010147:Pain Measurement / Q000187:drug effects; D011343:Procaine / Q000009:adverse effects / Q000031:analogs & derivatives*; D011537:Pruritus / Q000139:chemically induced
D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D011343:Procaine; C004616:chloroprocaine; D008012:Lidocaine; D005283:Fentanyl